TAILIEUCHUNG - Interferon-c Release Assays for Active Pulmonary Tuberculosis Diagnosis in Adults in Low- and Middle-Income Countries: Systematic Review and Meta-analysis

We included studies that evaluated the performance of the most recent generation of commercial, RD1 antigen-based IGRAs (QFT-GIT and T-SPOT) among adults (age $15 years) with suspected active pulmonary tuberculosis or confirmed tuberculosis in low- and middle-income countries [22]; the World Bank Country Classification was considered as a surrogate for national tuberculosis incidence. HIV infection was established either by documented serological testing or self-report. We excluded (1) studies that evaluated noncommercial (in-house) IGRAs, purified protein derivative–based IGRAs, QuantiFERONTB Gold (2G), and IGRAs performed using specimens other than blood; (2) longitudinal data focused on the effect of antituberculosis treatment on IGRA response; (3) studies including ,10 eligible individuals; (4) studies focused on extrapulmonary tuberculosis or. | SUPPLEMENT ARTICLE Interferon-y Release Assays for Active Pulmonary Tuberculosis Diagnosis in Adults in Low- and Middle-Income Countries Systematic Review and Meta-analysis John Z. Metcalfe 1-2 Charles K. Everett 1 Karen R. Steingart 2 Adithya Cattamanchi 1-2 Laurence Huang 1-3 Philip C. Hopewell 1 2 and Madhukar Pai4 Division of Pulmonary and Critical Care Medicine San Francisco General Hospital department of Health Services University of Washington School of Public Health Seattle 3HIV AIDS Division San Francisco General Hospital University of California and department of Epidemiology Biostatistics and Occupational Health McGill University Montreal Canada Background. The diagnostic value of interferon-y release assays IGRAs for active tuberculosis in low- and middle-income countries is unclear. Methods. We searched multiple databases for studies published through May 2010 that evaluated the diagnostic performance of QuantiFERON-TB Gold In-Tube QFT-GIT and T-SPOT among adults with suspected active pulmonary tuberculosis or patients with confirmed cases in low- and middle-income countries. We summarized test performance characteristics with use of forest plots hierarchical summary receiver operating characteristic HSROC curves and bivariate random effects models. Results. Our search identified 789 citations of which 27 observational studies 17 QFT-GIT and 10 T-SPOT evaluating 590 human immunodeficiency virus HIV -uninfected and 844 HIV-infected individuals met inclusion criteria. Among HIV-infected patients HSROC bivariate pooled sensitivity estimates highest quality data were 76 95 confidence interval CI 45 -92 for T-SPoT and 60 95 CI 34 -82 for qFt-GIT. HSROC bivariate pooled specificity estimates were low for both IGRA platforms among all participants T-SPOT 61 95 CI 40 -79 QFT-GIT 52 95 CI 41 -62 and among HIV-infected persons T-SPOT 52 95 CI 40 -63 QFT-GIT 50 95 CI 35 -65 . There was no consistent evidence that either IGRA was more sensitive than the

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