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Characterization of QuantiFERON-TB-Plus results in latent tuberculosis infected patients with or without immune-mediated inflammatory diseases

Published:April 11, 2019DOI:https://doi.org/10.1016/j.jinf.2019.04.010

      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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