Rapid detection of active and latent tuberculosis infection in HIV-positive individuals by enumeration of Mycobacterium tuberculosis-specific T cells
Rapid detection of active and latent tuberculosis infection in HIV-positive individuals by enumeration of Mycobacterium tuberculosis-specific T cells
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DOI：
10.1097/00002030-200211220-00008
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发表时间：
2002-11-22
期刊：
影响因子：
3.8
通讯作者：
Lalvani, A
中科院分区：
文献类型：
--
作者：
Chapman, ALN;Munkanta, M;Lalvani, A
目的：迫切需要一种准确的结核分枝杆菌感染检测方法。结核菌素皮肤试验(TST)缺乏敏感性，尤其是在HIV感染者中，而且由于与卡介苗(BCG)疫苗的抗原交叉反应，特异性较差。ESAT-6和CFP-10是在结核分枝杆菌中表达的抗原，而在牛分枝杆菌和大多数环境分枝杆菌中不表达。方法：采用体外酶联免疫斑点法(ELISPOT)对50例赞比亚结核病患者、75例赞比亚健康成人和40例健康英国居民的血样进行ESAT-6、CFP-10和PPD特异性T细胞计数。结果：所有(100%；n=11)和90%(n=39)HIV阴性和HIV阳性结核病患者均可检测到ESAT-6或CFP-10特异性T细胞。基于ESAT-6/CFP-10的ELISPOT检测在54名HIV阴性的健康赞比亚人中有37人呈阳性，表明潜在结核分枝杆菌感染的流行率为69%。较少的HIV阳性赞比亚人拥有ESAT-6/CFP-10特异性T细胞，但HIV感染对这项检测的影响小于基于PPD的ELISPOT或TST。结论：基于ESAT-6/CFP-10的ELISPOT方法检测HIV阳性患者的活动性结核病具有高灵敏度。它比基于PPD的检测潜在结核分枝杆菌感染的方法更特异，也可能更敏感，并可能潜在地改善针对艾滋病毒阳性患者潜在结核病感染的异烟肼预防性治疗。(C)2002年，里平科特·威廉姆斯·威尔金斯。
Objectives: An accurate test for Mycobacterium tuberculosis infection is urgently needed. The tuberculin skin test (TST) lacks sensitivity, particularly in HIV-infected individuals, and has poor specificity because of antigenic cross-reactivity with Bacillus Calmette-Guerin (BCG) vaccination. ESAT-6 and CFP-10 are antigens expressed in M. tuberculosis, but not in Mycobacterium bovis BCG and most environmental mycobacteria. We investigated whether T cells specific for these antigens could serve as accurate markers of M. tuberculosis infection in an area of high tuberculosis and HIV prevalence.Methods: Using the rapid ex-vivo enzyme-linked immunospot (ELISPOT) assay for IFN-gamma, we enumerated T cells specific for ESAT-6, CFP-10 and purified protein derivative (PPD) in blood samples from 50 Zambian tuberculosis patients, 75 healthy Zambian adults, and 40 healthy UK residents. TSTs were performed in 49 healthy Zambian adults.Results: All (100%; n = 11) and 90% (n = 39) of HIV-negative and HIV-positive tuberculosis patients, respectively, had detectable ESAT-6- or CFP-10-specific T cells. The ESAT-6/CFP-10-based ELISPOT assay was positive in 37 out of 54 HIV-negative healthy Zambians, suggesting a 69% prevalence of latent M. tuberculosis infection. Fewer HIV-positive Zambians possessed ESAT-6/CFP-10-specific T cells, but the impact of HIV infection was less on this assay than on the PPD-based ELISPOT or TST.Conclusion: The ESAT-6/CFP-10-based ELISPOT assay detects active tuberculosis in HIV-positive individuals with high sensitivity. It is more specific, and possibly more sensitive, than PPD-based methods of detecting latent M. tuberculosis infection, and may potentially improve the targeting of isoniazid preventative therapy to HIV-positive individuals with latent tuberculosis infection. (C) 2002 Lippincott Williams Wilkins.