Adolescent Health in Myanmar
Support Burnet’s Adolescent Health Programs in Myanmar today.
Support Burnet’s Adolescent Health Programs in Myanmar today.
Support Burnet’s Adolescent Health Programs in Myanmar today.
Support Burnet’s Adolescent Health Programs in Myanmar today.
BACKGROUND:: There is limited data from high-income countries on the performance of interferon-gamma releasing assays in screening for latent tuberculosis infection (LTBI). We analysed the routine application of the Quantiferon-TB Gold (QFT-G) assay, to detect and predict latent and active tuberculosis among HIV-infected patients in Australia. METHODS:: A retrospective cohort study included all HIV-infected patients attending the Melbourne Sexual Health Service between March 2003 and February 2011 who were screened for LTBI using QFT-G. Clinical data was analysed in multivariable models to determine predictors for QFT-G positivity using logistic regression, and active tuberculosis development using Cox proportional hazards. RESULTS:: 917 HIV-infected patients had >/=1 QFT-G performed, of whom 884 (96.4%) were negative, 29 (3.2%) positive, and four (0.4%) indeterminate. The mean age was 40.9 years, 88% were male, with median follow-up of 26.4 (IQR 15.4-30.7) months. 550 (63%) were Australian-born, while 198 (23%) were born in Asia or Africa. QFT-G was positive in 2.0% of Australian-born and 5.3% overseas-born patients (odds ratio[OR] 2.6, 95% CI 1.2-5.6, p=0.017); and 12.7% African-born patients (OR 7.1, 95% CI 2.9-17.3, p<0.001). Two cases of culture-positive tuberculosis occurred after QFT-G screening in 3.4% of QFT-G-positive and 0.1% of QFT-G-negative patients (adjusted hazard ratio 42.4, 95% CI 2.2-827, p=0.013); a rate of 111 (95% CI 27.8-445) per 100,000 person-years:. CONCLUSIONS:: In this context, QFT-G has a high negative predictive (99.9%) value with few indeterminate results. A risk-stratification approach to LTBI screening, where HIV-infected patients with epidemiological risk-factors for tuberculosis infection undergo QFT-G testing, might be clinically appropriate and potentially cost-effective in similar settings.