Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: a systematic review and meta-analysis.
Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: a systematic review and meta-analysis.
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DOI：
10.1097/qai.0b013e31820b07ab
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发表时间：
2011-03-01
期刊：
影响因子：
--
通讯作者：
Pai M
中科院分区：
文献类型：
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作者：
Cattamanchi A;Smith R;Steingart KR;Metcalfe JZ;Date A;Coleman C;Marston BJ;Huang L;Hopewell PC;Pai M
确定干扰素-γ释放试验（IGRAs）是否能提高对可能从LTBI治疗中获益的HIV感染者的识别。系统回顾和荟萃分析.我们检索了截至2010年5月的多个数据库，以获得评价最新市售IGRA（QuantiFERON-Gold In-tube [QFT-GIT]和T-SPOT）性能的研究。TB [TSPOT]）。我们评估了纳入综述的所有研究的质量，使用森林图总结了预先指定的亚组的结果，并在适当的情况下，使用随机效应模型计算了汇总估计值。检索确定了37项研究，其中包括5736名艾滋病毒感染者。在3项纵向研究中，IGRA结果阳性的HIV感染者患活动性结核病的风险高于IGRA结果阴性的HIV感染者。然而，在2项研究中，风险差异没有统计学意义，报告IGRA的结果，根据专家推荐的标准。在活动性TB（LTBI的替代参考标准）患者中，合并的敏感性估计值具有异质性，但TSPOT（72%，95% CI 62-81%）高于QFT-GIT（61%，95% CI 41-75%）。然而，无论是IGRA始终比结核菌素皮肤试验（TST）在头对头比较更敏感。虽然TSPOT似乎比QFT-GIT和TST受免疫抑制的影响更小，但总体而言，三种测试之间的差异很小或不确定。目前的证据表明，IGRA在识别HIV感染者LTBI方面与TST的表现相似。鉴于这两种检验方法的预测价值都不高，灵敏度也不理想，应根据国家准则以及资源和后勤方面的考虑，决定使用哪一种检验方法。
To determine whether interferon-gamma release assays (IGRAs) improve the identification of HIV-infected individuals who could benefit from LTBI therapy. Systematic review and meta-analysis. We searched multiple databases through May2010 for studies evaluating the performance of the newest commercial IGRAs (QuantiFERON-Gold In-tube [QFT-GIT] and T-SPOT. TB [TSPOT])in HIV-infected individuals. We assessed the quality of all studies included in the review, summarized results in pre-specified sub-groups using forest plots, and where appropriate, calculated pooled estimates using random effects models. The search identified 37 studies that included 5736 HIV-infected individuals. In3 longitudinal studies, the risk of active TB was higher in HIV-infected individuals with positive versus negative IGRA results. However, the risk difference was not statistically significant in the 2 studies that reported IGRA results according to manufacturer-recommended criteria. In persons with active TB(a surrogate reference standard for LTBI), pooled sensitivity estimates were heterogeneous, but higher for TSPOT (72%, 95% CI 62–81%) than for QFT-GIT (61%, 95% CI 41–75%). However, neither IGRA was consistently more sensitive than the tuberculin skin test (TST) in head-to-head comparisons. While TSPOT appeared to be less affected by immunosuppression than QFT-GIT and TST, overall, differences between the three tests were small or inconclusive. Current evidence suggests that IGRAs perform similarly to the TST at identifying HIV-infected individuals with LTBI. Given that both tests have modest predictive value and sub-optimal sensitivity, the decision to use either test should be based on country guidelines and resource and logistical considerations.