Interferon-γ release assays for the diagnosis of tuberculosis and tuberculosis infection in HIV-infected adults: a systematic review and meta-analysis.
Interferon-γ release assays for the diagnosis of tuberculosis and tuberculosis infection in HIV-infected adults: a systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0032482
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Rigau D
中科院分区：
文献类型：
--
作者：
Santin M;Muñoz L;Rigau D
尽管干扰素γ释放测定法（IGRAs）被广泛使用，但其在hiv感染患者诊断结核病和靶向预防治疗中的作用尚不清楚。我们进行了一项全面的系统综述，以促进艾滋病毒感染者的循证实践。我们检索了MEDLINE、Cochrane和生物医学数据库，以确定2005年1月至2011年7月间发表的评估QuantiFERON®-TB Gold In-Tube （QFT-GIT）和T-SPOT®的文章。艾滋病毒感染成人的结核（T-SPOT.TB）。我们评估了它们诊断结核病和活动性结核病的准确性，以及不确定结果的比例。这项研究确定了38项可评估的研究，涉及6514名艾滋病毒感染者。QFT-GIT对结核病的敏感性和特异性分别为61%和72%，T-SPOT.TB的敏感性和特异性分别为65%和70%。随后活动性结核的累积发病率在QFT-GIT组为8.3%，在T-SPOT组为10%。结核病患者检测呈阳性（各一项研究），QFT-GIT（两项研究）和T-SPOT为0%。结核病（一项研究）分别检测为阴性。QFT-GIT和T-SPOT.TB的总不确定率分别为8.2%和5.9%。在高负担环境中，发病率更高（QFT-GIT为12.0%，T-SPOT为7.7%）。相比于中低负担环境（QFT-GIT为3.9%,T-SPOT.TB为4.3%）。CD4+ t细胞计数<200的患者也更高（QFT-GIT为11.6%，T-SPOT为11.4%）。CD4+ t细胞计数≥200 （QFT-GIT为3.1%,T-SPOT.TB为7.9%）。IGRAs在确认或排除艾滋病毒感染成人活动性结核病方面的准确性不理想。虽然它们对活动性结核病事件的预测价值不大，但负的QFT-GIT意味着中短期风险非常低。确定与不确定结果相关的因素将有助于优化IGRAs在临床实践中的使用，特别是在艾滋病毒合并感染流行率高的资源有限的国家。
Despite the widespread use of interferon-γ release assays (IGRAs), their role in diagnosing tuberculosis and targeting preventive therapy in HIV-infected patients remains unclear. We conducted a comprehensive systematic review to contribute to the evidence-based practice in HIV-infected people. We searched MEDLINE, Cochrane, and Biomedicine databases to identify articles published between January 2005 and July 2011 that assessed QuantiFERON®-TB Gold In-Tube (QFT-GIT) and T-SPOT®.TB (T-SPOT.TB) in HIV-infected adults. We assessed their accuracy for the diagnosis of tuberculosis and incident active tuberculosis, and the proportion of indeterminate results. The search identified 38 evaluable studies covering a total of 6514 HIV-infected participants. The pooled sensitivity and specificity for tuberculosis were 61% and 72% for QFT-GIT, and 65% and 70% for T-SPOT.TB. The cumulative incidence of subsequent active tuberculosis was 8.3% for QFT-GIT and 10% for T-SPOT.TB in patients tested positive (one study each), and 0% for QFT-GIT (two studies) and T-SPOT.TB (one study) respectively in those tested negative. Pooled indeterminate rates were 8.2% for QFT-GIT and 5.9% for T-SPOT.TB. Rates were higher in high burden settings (12.0% for QFT-GIT and 7.7% for T-SPOT.TB) than in low-intermediate burden settings (3.9% for QFT-GIT and 4.3% for T-SPOT.TB). They were also higher in patients with CD4+ T-cell count <200 (11.6% for QFT-GIT and 11.4% for T-SPOT.TB) than in those with CD4+ T-cell count ≥200 (3.1% for QFT-GIT and 7.9% for T-SPOT.TB). IGRAs have suboptimal accuracy for confirming or ruling out active tuberculosis disease in HIV-infected adults. While their predictive value for incident active tuberculosis is modest, a negative QFT-GIT implies a very low short- to medium-term risk. Identifying the factors associated with indeterminate results will help to optimize the use of IGRAs in clinical practice, particularly in resource-limited countries with a high prevalence of HIV-coinfection.
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