The Role of QuantiFERON®-TB Gold and Tuberculin Skin Test as Diagnostic Tests for Intraocular Tuberculosis in HIV-Positive and HIV-Negative Patients in South Africa

Ocul Immunol Inflamm. 2018;26(6):853-858. doi: 10.1080/09273948.2017.1327078. Epub 2017 Jun 19.

Abstract

Purpose: To compare QuantiFERON®-TB Gold and tuberculin skin testing as diagnostic tests for intraocular tuberculosis in HIV positive and negative patients.

Methods: A prospective study evaluating two different tests to help diagnose intraocular tuberculosis.

Results: Thirty-five of 106 patients (33.0%) were diagnosed with intraocular tuberculosis including 11 (31.4%) with HIV infection. Patients were 6.95 times more likely to have intraocular tuberculosis if TST alone was positive (p < 0.001) versus 2.19 times more likely if Quantiferon alone was positive (p = 0.04). Tuberculin skin testing showed superior specificity (60.3% vs 33.3%) (p = 0.001) but similar sensitivity (90.3% vs 85.7%), positive (54.9% vs 40.5%) and negative predictive values (92.1% vs 81.5%) compared to Quantiferon. Specificity did not increase significantly if both skin testing and Quantiferon were positive.

Conclusions: In South Africa, with its high HIV burden and limited public health resources, Quantiferon testing should not replace tuberculin skin testing as it provides little additional diagnostic information.

Keywords: HIV; Quantiferon; South Africa; diagnosis; intraocular tuberculosis; tuberculin skin test.

MeSH terms

  • Adult
  • Antibodies, Bacterial / analysis
  • Female
  • HIV / immunology*
  • HIV Antibodies / analysis*
  • HIV Seronegativity*
  • HIV Seropositivity*
  • Humans
  • Incidence
  • Male
  • Mycobacterium tuberculosis / immunology
  • Mycobacterium tuberculosis / isolation & purification*
  • Prospective Studies
  • South Africa / epidemiology
  • Tuberculin Test / methods*
  • Tuberculosis, Ocular / diagnosis*
  • Tuberculosis, Ocular / epidemiology
  • Tuberculosis, Ocular / microbiology

Substances

  • Antibodies, Bacterial
  • HIV Antibodies