Effect of Pregnancy on Interferon Gamma Release Assay and Tuberculin Skin Test Detection of Latent TB Infection Among HIV-Infected Women in a High Burden Setting

• Type of Material: Article
• Authors: Sylvia M. LaCourse, University of Washington; Lisa Marie Cranmer, Emory University; Daniel Matemo, Kenyatta National Hospital; John Kinuthia, Kenyatta National Hospital; Barbra A. Richardson, University of Washington; David J. Horne, University of Washington; Grace John-Stewart, University of Washington
• Language: English
• Date: 2017-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 The Author(s). Published by Wolters Kluwer Health, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000001298
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 75
• Issue: 1
• Start Page: 128
• End Page: 136
• Grant/Funding Information: This work was supported by the National Institute of Allergy and Infectious Diseases and the National Institute of Child Health and Human Development at the National Institutes of Health [K23 AI 120793-01 and T32 AI07140 to SML, K23 AI 85036-01 to DJH, K24 HD054314-06 to GJS, K12 HD000850 to LMC], University of Washington Center for AIDS Research (CFAR) P30AI027757 to SML, UW INTERSECT-Ellison Fellowship to SML, the National Center for Research Resources at the National Institutes of Health [UL1TR000423] and the Firland Foundation.
• Keywords: tuberculin skin testing; Infectious Diseases; Science & Technology; PREVALENCE; latent tuberculosis infection; ADOLESCENTS; PERFORMANCE; interferon gamma release assay; Life Sciences & Biomedicine; INDIVIDUALS; COMMUNITY; diagnostics; DIAGNOSIS; ACTIVE TUBERCULOSIS; HIV; pregnancy; POSTPARTUM WOMEN; QuantiFERON TB Gold In-tube; Immunology; MORTALITY; TEST CONVERSION
• Research Categories: Health Sciences, Obstetrics and Gynecology; Biology, Biostatistics; Health Sciences, Immunology

Abstract

Background: Peripartum immunologic changes may affect latent tuberculosis infection (LTBI) diagnostic performance among HIVinfected women. Methods: HIV-infected women were serially tested with tuberculin skin test (TST) and interferon gamma release assay [QuantiFERON TB Gold In-tube (QFT)] in pregnancy and 6 weeks postpartum in Kenya. Prevalence, sensitivity and agreement, and correlates of QFT/TST positivity were assessed. Quantitative QFT mitogen and Mycobacterium tuberculosis antigen (Mtb-Ag) responses were compared by peripartum stage. Incidence of test conversion at 6 weeks postpartum was evaluated in baseline TST2/QFT2 women. Results: Among 100 HIV-infected women, median age was 26 years, median CD4 was 555 cells per cubic millimeter, and 88% were on antiretrovirals. More women were QFT+ than TST+ in both pregnancy (35.4% vs. 13.5%, P = 0.001) and postpartum (29.6% vs. 14.8%, P , 0.001). Among 18 consistently QFT+ women, 8 (44%) converted from TST2 to TST+, with improved test agreement postpartum (56.9%, k = 0.20 to 82.4%, k = 0.60). Three initially QFT2/TST2 women had test conversion (TST+ and/or QFT+), suggesting new infection (incidence 13.4/100 person-years). Mean QFT mitogen (4.46 vs. 7.64 IU/mL, P , 0.001) and Mtb-Ag (1.03 vs. 1.54 IU/mL, P = 0.03) responses were lower among all women retested in pregnancy vs. postpartum, and specifically among persistently QFT+ women (Mtb-Ag: 3.46 vs. 4.48 IU/mL, P = 0.007). QFT indeterminate rate was higher in pregnancy (16%) compared with postpartum (0%) because of lower mitogen response. Conclusions: QFT identified .2-fold more women with LTBI compared with TST in pregnancy and postpartum. Lower QFT Mtb-Ag and mitogen responses in pregnancy compared with postpartum suggest that pregnancy-associated immunologic changes may influence LTBI test performance.