QuantiFERON conversion following tuberculin administration is common in HIV infection and relates to baseline response

File Description SizeFormat 
Boosting IGRA accepted_ 26SEP16.pdfAccepted version855.39 kBAdobe PDFView/Open
art%3A10.1186%2Fs12879-016-1875-6.pdfPublished version511.84 kBAdobe PDFView/Open
Title: QuantiFERON conversion following tuberculin administration is common in HIV infection and relates to baseline response
Authors: Esmail, H
Thienemann, F
Oni, T
Goliath, RT
Wilkinson, KA
Wilkinson, RJ
Item Type: Journal Article
Abstract: Background: HIV-1 infection impairs tuberculosis (TB) specific immune responses affecting the diagnosis of latent TB. We aimed to (1) determine the proportion of HIV-1-infected adults with a negative QuantiFERON®-TB Gold in-tube (QFT-GIT) and Tuberculin skin testing (TST) that convert to QFT-GIT positive following TST, and (2) evaluate the relationship between conversion and baseline QFT-GIT results. Methods: HIV-1 infected adults being screened for a TB vaccine study in South Africa underwent QFT-GIT followed by TST. As per protocol, QFT-GIT was repeated if randomization was delayed allowing for evaluation of TST boosting in a proportion of participants. Results: Of the 22 HIV-1 infected, TST and QFT-GIT negative adults (median CD4 477/mm3 IQR 439–621) who had QFT-GIT repeated after median 62 days (IQR 49–70), 40.9 % (95 % CI 18.6–63.2 %) converted. Converters had a significantly greater increase in the background subtracted TB antigen response (TBAg-Nil – all units IU/mL) following TST, 0.82 (IQR 0.39–1.28) vs 0.03 (IQR −0.05–0.06), p = 0.0001. Those who converted also had a significantly higher baseline TBAg-Nil 0.21(IQR 0.17–0.26) vs 0.02(IQR 0.01–0.07), p = 0.002. Converters did not differ with regard to CD4 count or ART status. ROC analysis showed a baseline cut off of 0.15 correctly classified 86.4 % of converters with 88.9 % sensitivity. Conclusions: Our findings support the possibility that there are 2 distinct groups in an HIV-1 infected population with negative QFT-GIT and TST; a true negative group and a group showing evidence of a weak Mtb specific immune response that boosts significantly following TST resulting in conversion of the test result that may represent false negatives. Further evaluation of whether a lower cut off may improve sensitivity of QFT-GIT in this population is warranted.
Issue Date: 7-Oct-2016
Date of Acceptance: 26-Sep-2016
ISSN: 1471-2334
Publisher: BioMed Central
Journal / Book Title: BMC Infectious Diseases
Volume: 16
Copyright Statement: © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: Wellcome Trust
Wellcome Trust
Funder's Grant Number: 090170/Z/09/Z
Keywords: Microbiology
0605 Microbiology
1103 Clinical Sciences
1108 Medical Microbiology
Publication Status: Published
Article Number: 545
Appears in Collections:Department of Medicine
Faculty of Medicine

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commons