PMID- 37159954
OWN - NLM
STAT- MEDLINE
DCOM- 20240318
LR  - 20240318
IS  - 2325-6621 (Electronic)
IS  - 2329-6933 (Print)
IS  - 2325-6621 (Linking)
VI  - 20
IP  - 9
DP  - 2023 Sep
TI  - Examining Test Cutoffs to Optimize Diagnosis of Latent Tuberculosis Infection in 
      People Born Outside the United States.
PG  - 1258-1266
LID - 10.1513/AnnalsATS.202212-1005OC [doi]
AB  - Rationale: Detection of latent tuberculosis infection (LTBI) in persons born in 
      high tuberculosis (TB) incidence countries living in low TB incidence countries 
      is key to TB elimination in low-incidence countries. Optimizing LTBI tests is 
      critical to targeting treatment. Objectives: To compare the sensitivity and 
      specificity of tuberculin skin test (TST) and two interferon-gamma release assays at 
      different cutoffs and of a single test versus dual testing. Methods: We examined 
      a subset (N = 14,167) of a prospective cohort of people in the United States 
      tested for LTBI. We included non-U.S.-born, human immunodeficiency 
      virus-seronegative people ages 5 years and older with valid TST, QuantiFERON-TB 
      Gold-in-Tube (QFT), and T-SPOT.TB (TSPOT) results. The sensitivity/specificity of 
      different test cutoffs and test combinations, obtained from a Bayesian latent 
      class model, were used to construct receiver operating characteristic (ROC) 
      curves and assess the area under the curve (AUC) for each test. The 
      sensitivity/specificity of dual testing was calculated. Results: The AUC of the 
      TST ROC curve was 0.81 (95% credible interval (CrI), 0.78-0.86), with 
      sensitivity/specificity at cutoffs of 5, 10, and 15 mm of 86.5%/61.6%, 
      81.7%/71.3%, and 55.6%/88.0%, respectively. The AUC of the QFT ROC curve was 0.89 
      (95% CrI, 0.86-0.93), with sensitivity/specificity at cutoffs of 0.35, 0.7, and 
      1.0 IU/mL of 77.7%/98.3%, 66.9%/99.1%, and 61.5%/99.4%. The AUC of the TSPOT ROC 
      curve was 0.92 (95% CrI, 0.88-0.96) with sensitivity/specificity for five, six, 
      seven, and eight spots of 79.2%/96.7%, 76.8%/97.7%, 74.0%/98.6%, and 71.8%/99.5%. 
      Sensitivity/specificity of TST-QFT, TST-TSPOT, and QFT-TSPOT at standard cutoffs 
      were 73.1%/99.4%, 64.8%/99.8%, and 65.3%/100%. Conclusion: Interferon-gamma release 
      assays have a better predictive ability than TST in people at high risk of LTBI.
FAU - Zavala, Sofia
AU  - Zavala S
AUID- ORCID: 0000-0003-1269-2959
AD  - Division of Infectious Diseases and International Health, Department of Medicine, 
      Duke University Medical Center, Durham, North Carolina.
FAU - Winglee, Kathryn
AU  - Winglee K
AD  - Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 
      Atlanta, Georgia.
FAU - Ho, Christine S
AU  - Ho CS
AD  - Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 
      Atlanta, Georgia.
FAU - Pettit, April C
AU  - Pettit AC
AUID- ORCID: 0000-0001-8832-0866
AD  - Division of Infectious Diseases, Department of Medicine, Vanderbilt University 
      Medical Center, Nashville, Tennessee.
FAU - Ahmed, Amina
AU  - Ahmed A
AD  - Department of Pediatrics, Atrium Health, Charlotte, North Carolina; and.
FAU - Katz, Dolly J
AU  - Katz DJ
AD  - Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 
      Atlanta, Georgia.
FAU - Belknap, Robert W
AU  - Belknap RW
AD  - Denver Health and Hospital Authority, Denver, Colorado.
FAU - Stout, Jason E
AU  - Stout JE
AUID- ORCID: 0000-0002-6698-8176
AD  - Division of Infectious Diseases and International Health, Department of Medicine, 
      Duke University Medical Center, Durham, North Carolina.
LA  - eng
GR  - CC999999/ImCDC/Intramural CDC HHS/United States
PT  - Journal Article
PL  - United States
TA  - Ann Am Thorac Soc
JT  - Annals of the American Thoracic Society
JID - 101600811
SB  - IM
MH  - Humans
MH  - *Latent Tuberculosis/diagnosis/epidemiology
MH  - Prospective Studies
MH  - Bayes Theorem
MH  - Interferon-gamma Release Tests/methods
MH  - Tuberculin Test/methods
MH  - *Tuberculosis
PMC - PMC10938364
MID - NIHMS1961441
OTO - NOTNLM
OT  - interferon gamma release assay
OT  - latent class analysis
OT  - latent tuberculosis
OT  - test cutoffs
OT  - tuberculin skin test
EDAT- 2023/05/09 18:41
MHDA- 2024/03/18 06:43
PMCR- 2024/09/01
CRDT- 2023/05/09 17:53
PHST- 2024/09/01 00:00 [pmc-release]
PHST- 2024/03/18 06:43 [medline]
PHST- 2023/05/09 18:41 [pubmed]
PHST- 2023/05/09 17:53 [entrez]
AID - 10.1513/AnnalsATS.202212-1005OC [doi]
PST - ppublish
SO  - Ann Am Thorac Soc. 2023 Sep;20(9):1258-1266. doi: 
      10.1513/AnnalsATS.202212-1005OC.