Interferon-gamma Release Assays for Active Pulmonary Tuberculosis Diagnosis in Adults in Low- and Middle-Income Countries: Systematic Review and Meta-analysis

  • Metcalfe J
  • Everett C
  • Steingart K
 et al. 
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Background. The diagnostic value of interferon-gamma release assays
(IGRAs) for active tuberculosis in low- and middle-income countries
is unclear. Methods. We searched multiple databases for studies published
through May 2010 that evaluated the diagnostic performance of QuantiFERON-TB
Gold In-Tube (QFT-GIT) and T-SPOT.TB (T-SPOT) among adults with suspected
active pulmonary tuberculosis or patients with confirmed cases in
low- and middle-income countries. We summarized test performance
characteristics with use of forest plots, hierarchical summary receiver
operating characteristic (HSROC) curves, and bivariate random effects
models. Results. Our search identified 789 citations, of which 27
observational studies (17 QFT-GIT and 10 T-SPOT) evaluating 590 human
immunodeficiency virus (HIV)-uninfected and 844 HIV-infected individuals
met inclusion criteria. Among HIV-infected patients, HSROC/bivariate
pooled sensitivity estimates (highest quality data) were 76% (95%
confidence interval {[}CI], 45%-92%) for T-SPOT and 60% (95%
CI, 34%-82%) for QFT-GIT. HSROC/bivariate pooled specificity estimates
were low for both IGRA platforms among all participants (T-SPOT,
61% {[}95% CI, 40%-79%]; QFT-GIT, 52% {[}95% CI, 41%-62%])
and among HIV-infected persons (T-SPOT, 52% {[}95% CI, 40%-63%];
QFT-GIT, 50% {[}95% CI, 35%-65%]). There was no consistent evidence
that either IGRA was more sensitive than the tuberculin skin test
for active tuberculosis diagnosis. Conclusions. In low- and middle-income
countries, neither the tuberculin skin test nor IGRAs have value
for active tuberculosis diagnosis in adults, especially in the context
of HIV coinfection.

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  • John Z Metcalfe

  • Charles K Everett

  • Karen R Steingart

  • Adithya Cattamanchi

  • Laurence Huang

  • Philip C Hopewell

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