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Abstract
Rationale: Interferon-gamma release assays are used to diagnose tuberculosis infection. In developed countries, high rates of reversion following conversion have been described. Objectives: Assess QuantiFERON® TB Gold In-tube (QFT) conversion and reversion dynamics in a tuberculosis-endemic setting. Methods. Adolescents aged 12-18 residing near Cape Town were recruited. Tuberculin skin testing (TST) and QFT were performed at baseline and after 2 years of follow-up; half also had TST and QFT performed at additional time points. Participants were observed for incident tuberculosis disease for up to five years. Measurements and Main Results. Among 5,357 participants, 2,751 (51.4%) and 2,987 (55.8%) were positive by QFT and TST at baseline. Annualized QFT and TST conversion risks were 14.0% and 13.0%, respectively; reversion risks were 5.1% and 4.1%. Concordance was excellent for conversions (? = 0.74), but poor for reversions (? = 0.12). Among recent QFT converters, magnitude of QFT value was strongly inversely associated with risk of reversion (p<0.0001). When longitudinal QFT data were analyzed in a cross-sectional manner, the annual risk of infection was 7.3%, whereas inclusion of reversions in the analysis showed that the actual risk of infection was 14.0%. Incident tuberculosis was 8-fold higher among QFT reverters, compared with persons with all negative QFT results (1.47 vs. 0.18 cases/100 person-years, p=0.011). Conclusions. In this tuberculosis-endemic setting, annual risk of infection was extremely high, while QFT and TST conversion concordance were higher and QFT reversion rates were lower than reported from low-burden settings.
View details for DOI 10.1164/rccm.201409-1704OC
View details for PubMedID 25562578