Highlights
- •IFN-γ response to QFT-P is lower in IMID-LTBI compared to LTBI without IMID.
- •IMID status does not impact the ability to respond simultaneously to TB1 and TB2.
- •Similar proportion of discordant TB1 and TB2 results in IMID-LTBI and LTBI.
- •IMID-LTBI patients have a high probability to have QFT-P results in the grey zone range.
- •Type of IMID therapy does not impact the distribution of IFNγ results to QFT-P.
Summary
Objectives
Screening for latent tuberculosis infection (LTBI) diagnosis is mandatory in patients
with immune-mediated inflammatory diseases (IMID) requiring biologics. QuantiFERON-TB-Plus
(QFT-P), an LTBI diagnostic test, measures IFN-γ after M. tuberculosis-stimulation in TB1 and TB2 tubes in which a “CD4” or a “CD4 and CD8” response is
respectively elicited. Aim of this study is to compare the response to QFT-P of IMID-LTBI
patients candidates to a new biological therapy vs LTBI-subjects without IMID.
Methods
We prospectively enrolled 167 subjects: 61 IMID-LTBI and 106 NON-IMID-LTBI.
Results
All subjects were mitogen-responders. IFN-γ production was significantly lower in
IMID-LTBI-patients compared to NON-IMID-LTBI-subjects. We observed discordant TB1
and TB2 results in 6.5% of IMID-LTBI-patients and in 8% of NON-IMID-LTBI-subjects.
Applying a logistic regression analysis, we found that IMID-LTBI patients had a higher
probability (TB1 stimulation OR 3.32; TB2 stimulation OR 4.33) to have IFNγ results
≤0.7 IU/mL compared to NON-IMID-LTBI-subjects. Interestingly, IMID-treatment did not
interfere with the distribution of IFNγ-values.
Conclusions
These results indicate that IMID-LTBI-patients have a low IFN-γ response to QFT-P,
a high proportion of results ranging in the grey zone and a distribution of IFNγ-values
independent from the IMID-treatment. These results are important for the management
of LTBI screening in IMID patients.
Keywords
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Article info
Publication history
Published online: April 11, 2019
Accepted:
April 6,
2019
Identification
Copyright
© 2019 Published by Elsevier Ltd on behalf of The British Infection Association.