PMID- 32761083 OWN - NLM STAT- MEDLINE DCOM- 20211020 LR - 20240405 IS - 1537-6591 (Electronic) IS - 1058-4838 (Print) IS - 1058-4838 (Linking) VI - 73 IP - 7 DP - 2021 Oct 5 TI - Optimal Testing Choice and Diagnostic Strategies for Latent Tuberculosis Infection Among US-Born People Living with Human Immunodeficiency Virus (HIV). PG - e2278-e2284 LID - 10.1093/cid/ciaa1135 [doi] AB - BACKGROUND: Increased risk of progression from latent tuberculosis infection (LTBI) to tuberculosis (TB) disease among people living with human immunodeficiency virus (HIV; PLWH) prioritizes them for LTBI testing and treatment. Studies comparing the performance of interferon gamma release assays (IGRAs) and the tuberculin skin test (TST) among PLWH are lacking. METHODS: We used Bayesian latent class analysis to estimate the prevalence of LTBI and diagnostic characteristics of the TST, QuantiFERON Gold In-Tube (QFT), and T.SPOT-TB (TSPOT) among a prospective, multicenter cohort of US-born PLWH >/=5 years old with valid results for all 3 LTBI tests using standard US cutoffs (>/=5 mm TST, >/=0.35 IU/mL QFT, >/=8 spots TSPOT). We also explored the performance of varying LTBI test cutoffs. RESULTS: Among 1510 PLWH (median CD4+ count 532 cells/mm3), estimated LTBI prevalence was 4.7%. TSPOT was significantly more specific (99.7%) and had a significantly higher positive predictive value (90.0%, PPV) than QFT (96.5% specificity, 50.7% PPV) and TST (96.8% specificity, 45.4% PPV). QFT was significantly more sensitive (72.2%) than TST (54.2%) and TSPOT (51.9%); negative predictive value of all tests was high (TST 97.7%, QFT 98.6%, TSPOT 97.6%). Even at the highest cutoffs evaluated (15 mm TST, >/=1.00 IU/mL QFT, >/=8 spots TSPOT), TST and QFT specificity was significantly lower than TSPOT. CONCLUSIONS: LTBI prevalence among this cohort of US-born PLWH was low compared to non-US born persons. TSPOT's higher PPV may make it preferable for testing US-born PLWH at low risk for TB exposure and with high CD4+ counts. CI - (c) The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. FAU - Pettit, April C AU - Pettit AC AUID- ORCID: 0000-0001-8832-0866 AD - Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. FAU - Stout, Jason E AU - Stout JE AD - Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. FAU - Belknap, Robert AU - Belknap R AD - Denver Metro TB Clinic, Denver Health and Hospital Authority, Denver, Colorado, USA. FAU - Benson, Constance A AU - Benson CA AD - Department of Medicine, University of California San Diego School of Medicine, San Diego, California, USA. FAU - Seraphin, Marie Nancy AU - Seraphin MN AD - Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA. FAU - Lauzardo, Michael AU - Lauzardo M AD - Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA. FAU - Horne, David J AU - Horne DJ AD - Department of Medicine, University of Washington, Seattle, Washington, USA. FAU - Garfein, Richard S AU - Garfein RS AD - Department of Medicine, University of California San Diego School of Medicine, San Diego, California, USA. FAU - Maruri, Fernanda AU - Maruri F AD - Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. FAU - Ho, Christine S AU - Ho CS AD - Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. CN - Tuberculosis Epidemiologic Studies Consortium (TBESC) LA - eng GR - L30 AI146934/AI/NIAID NIH HHS/United States GR - P30 AI110527/AI/NIAID NIH HHS/United States GR - CC/CDC HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Clin Infect Dis JT - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JID - 9203213 SB - IM CIN - Clin Infect Dis. 2021 Oct 5;73(7):e2285-e2286. PMID: 32761073 MH - Bayes Theorem MH - Child, Preschool MH - HIV MH - *HIV Infections/complications/epidemiology MH - Humans MH - Interferon-gamma Release Tests MH - *Latent Tuberculosis/diagnosis/epidemiology MH - Prospective Studies MH - Tuberculin Test PMC - PMC8678585 OTO - NOTNLM OT - human immunodeficiency virus (HIV) OT - interferon gamma release assay (IGRA) OT - latent class analysis (LCA) OT - latent tuberculosis infection (LTBI) OT - tuberculin skin test (TST) FIR - Flood, Jennifer IR - Flood J FIR - Pascopella, Lisa IR - Pascopella L FIR - Higashi, Julie IR - Higashi J FIR - Moore, Marisa IR - Moore M FIR - Garfein, Richard IR - Garfein R FIR - Benson, Constance IR - Benson C FIR - Belknap, Robert IR - Belknap R FIR - Reves, Randall IR - Reves R FIR - Stout, Jason IR - Stout J FIR - Ahmed, Amina IR - Ahmed A FIR - Sterling, Timothy IR - Sterling T FIR - Pettit, April IR - Pettit A FIR - Stout, Jason IR - Stout J FIR - Blumberg, Henry M IR - Blumberg HM FIR - Lauzardo, Michael IR - Lauzardo M FIR - Seraphin, Marie Nancy IR - Seraphin MN FIR - Brostrom, Richard IR - Brostrom R FIR - Khurana, Renuka IR - Khurana R FIR - Cronin, Wendy IR - Cronin W FIR - Dorman, Susan IR - Dorman S FIR - Narita, Masahiro IR - Narita M FIR - Horne, David IR - Horne D FIR - Miller, Thaddeus IR - Miller T EDAT- 2020/08/08 06:00 MHDA- 2021/10/21 06:00 PMCR- 2021/08/06 CRDT- 2020/08/08 06:00 PHST- 2020/03/04 00:00 [received] PHST- 2020/08/01 00:00 [accepted] PHST- 2020/08/08 06:00 [pubmed] PHST- 2021/10/21 06:00 [medline] PHST- 2020/08/08 06:00 [entrez] PHST- 2021/08/06 00:00 [pmc-release] AID - 5881730 [pii] AID - ciaa1135 [pii] AID - 10.1093/cid/ciaa1135 [doi] PST - ppublish SO - Clin Infect Dis. 2021 Oct 5;73(7):e2278-e2284. doi: 10.1093/cid/ciaa1135.