Trajectories of interferon-gamma release assay results over two years in independent cohorts from China, South Africa, Tanzania, and the United States.

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE

Chest Pub Date : 2025-02-03 DOI:10.1016/j.chest.2025.01.031

Cheng Chen, Hao Xue, C Robert Horsburgh, Maryam Amour, Mark Hatherill, Michele Tameris, C Fordham von Reyn, Christiaan Rees, Ye Shen, Helen McShane, Alberto L García-Basteiro, Donglin Liu, Yijun Wang, Ruvandhi R Nathavitharana, Edward A Graviss, Yan Shao, Qiao Liu, Wei Lu, Limei Zhu, Leonardo Martinez

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引用次数: 0

Abstract

Background: There is an ongoing debate about whether clearance of Mycobacterium tuberculosis infection occurs and at what magnitude. Recent studies quantifying 'uncertainty zones' of interferon-gamma release assays (IGRA) provide a more stringent estimate of reversion, potentially indicating clearance.

Research question: When accounting for 'uncertainty zones' through stringent cutoffs, what are the trajectories of interferon-gamma release assays in cases of Mycobacterium tuberculosis infection?

Study design and methods: We followed five cohorts from South Africa, China, Tanzania, and the United States tested with an IGRA test three or more times for stringent conversion and reversion. The annual risk of IGRA reversion was assessed after an IGRA conversion and among those with baseline positivity.

Results: 26,596 IGRA measurements were taken over 13,593 years of follow-up (N_participants=7,683). Stringent reversion at year 2 after stringent conversion at year 1 varied between cohorts, occurring in 48% (43/90) for WANTAI, 37% (22/59) for QuantiFERON, and 17% (2/12) for T-SPOT.TB, respectively. In the U.S. cohorts, stringent reversion at year 1 after stringent conversion at 6 months was 58% (15/26) for QuantiFERON and 18% (12/60) for T-SPOT.TB. Stringent reversion at 1 year after baseline positivity occurred in 12% (47/404) for WANTAI, 21% (10/48) for QuantiFERON and 44% for T-SPOT.TB (45/102). In one cohort from (N=399; age range, 59 years [IQR, 48-67]), IGRA reversion was more common in younger participants (Adjusted Odds Ratio [aOR], 0.95; 95% CI, 0.93-0.97) and those without recent close tuberculosis exposure (aOR, 0.35; 95%CI, 0.11-1.03 in South Africa; 0.10; 95%CI, 0.01-0.61 in China).

Interpretation: These results suggest high annual rates of IGRA reversion, even with the use of 'uncertainty zones'; reversion rates decreased with time from exposure and at older ages.

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.