Characterization of QuantiFERON-TB-Plus results in latent tuberculosis infected patients with or without immune-mediated inflammatory diseases

Teresa Chiacchio; Elisa Petruccioli; Valentina Vanini; Gilda Cuzzi; Umberto Massafra; Gianpiero Baldi; Assunta Navarra; Rossana Scrivo; Claudio Mastroianni; Ilaria Sauzullo; Carmela Esposito; Fabrizio Palmieri; Fabrizio Cantini; Delia Goletti

doi:10.1016/j.jinf.2019.04.010

Characterization of QuantiFERON-TB-Plus results in latent tuberculosis infected patients with or without immune-mediated inflammatory diseases

J Infect. 2019 Jul;79(1):15-23. doi: 10.1016/j.jinf.2019.04.010. Epub 2019 Apr 11.

Affiliations

¹ Translational Research Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense 292, 00149 Rome, Italy.
² Department of Internal Medicine, S. Pietro Fatebenefratelli Hospital, Rome, Italy.
³ Rheumatology Unit, San Paolo Hospital, Civitavecchia, Rome, Italy.
⁴ Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Italy.
⁵ Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy.
⁶ Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
⁷ Department of Rheumatology, Hospital of Prato, Prato, Italy.
⁸ Department of Clinical and Clinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS Rome, Italy.
⁹ Translational Research Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense 292, 00149 Rome, Italy. Electronic address: delia.goletti@inmi.it.

PMID: 30981891
DOI: 10.1016/j.jinf.2019.04.010

Abstract

Objectives: Screening for latent tuberculosis infection (LTBI) diagnosis is mandatory in patients with immune-mediated inflammatory diseases (IMID) requiring biologics. QuantiFERON-TB-Plus (QFT-P), an LTBI diagnostic test, measures IFN-γ after M. tuberculosis-stimulation in TB1 and TB2 tubes in which a "CD4" or a "CD4 and CD8" response is respectively elicited. Aim of this study is to compare the response to QFT-P of IMID-LTBI patients candidates to a new biological therapy vs LTBI-subjects without IMID.

Methods: We prospectively enrolled 167 subjects: 61 IMID-LTBI and 106 NON-IMID-LTBI.

Results: All subjects were mitogen-responders. IFN-γ production was significantly lower in IMID-LTBI-patients compared to NON-IMID-LTBI-subjects. We observed discordant TB1 and TB2 results in 6.5% of IMID-LTBI-patients and in 8% of NON-IMID-LTBI-subjects. Applying a logistic regression analysis, we found that IMID-LTBI patients had a higher probability (TB1 stimulation OR 3.32; TB2 stimulation OR 4.33) to have IFNγ results ≤0.7 IU/mL compared to NON-IMID-LTBI-subjects. Interestingly, IMID-treatment did not interfere with the distribution of IFNγ-values.

Conclusions: These results indicate that IMID-LTBI-patients have a low IFN-γ response to QFT-P, a high proportion of results ranging in the grey zone and a distribution of IFNγ-values independent from the IMID-treatment. These results are important for the management of LTBI screening in IMID patients.

Keywords: Anti-TNFα; Biological therapy; IGRA; IMID; LTBI; QuantiFERON-TB-Plus; Tuberculosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Female
Humans
Inflammation / diagnosis*
Interferon-gamma Release Tests / methods*
Latent Tuberculosis / diagnosis*
Male
Mass Screening / methods*
Middle Aged
Mycobacterium tuberculosis / immunology*
Prospective Studies