Serial interferon-gamma release assays during treatment of active tuberculosis in young adults

Abstract

Background: The role of interferon-gamma release assay (IGRA) in monitoring responses to anti-tuberculosis (TB) treatment is not clear. We evaluated the results of the QuantiFERON-TB Gold In-tube (QFT-GIT) assay over time during the anti-TB treatment of adults with no underlying disease. Methods: We enrolled soldiers who were newly diagnosed with active TB and admitted to the central referral military hospital in South Korea between May 1, 2008 and September 30, 2009. For each participant, we preformed QFT-GIT assay before treatment (baseline) and at 1, 3, and 6 months after initiating anti-TB medication. Results: Of 67 eligible patients, 59 (88.1%) completed the study protocol. All participants were males who were human immunodeficiency virus (HIV)-negative and had no chronic diseases. Their median age was 21 years (range, 20-48). Initially, 57 (96.6%) patients had positive QFT-GIT results, and 53 (89.8%), 42 (71.2%), and 39 (66.1%) had positive QFT-GIT results at 1, 3, and 6 months, respectively. The IFN-gamma level at baseline was 5.31 +/- 5.34 IU/ml, and the levels at 1, 3, and 6 months were 3.95 +/- 4.30, 1.82 +/- 2.14, and 1.50 +/- 2.12 IU/ml, respectively. All patients had clinical and radiologic improvements after treatment and were cured. A lower IFN-gamma level, C-reactive protein >= 3 mg/dl, and the presence of fever (>= 38.3 degrees C) at diagnosis were associated with negative reversion of the QFT-GIT assay. Conclusion: Although the IFN-gamma level measured by QFT-GIT assay decreased after successful anti-TB treatment in most participants, less than half of them exhibited QFT-GIT reversion. Thus, the reversion to negativity of the QFT-GIT assay may not be a good surrogate for treatment response in otherwise healthy young patients with TB. ; Lee SSJ, 2009, INFECTION, V37, P96, DOI 10.1007/s15010-008-8082-3 ; Kobashi Y, 2009, J INFECTION, V58, P197, DOI 10.1016/j.jinf.2008.08.009 ; Katiyar SK, 2008, INT J TUBERC LUNG D, V12, P1146 ; Kobashi Y, 2008, CHEST, V133, P1196, DOI 10.1378/chest.07-1995 ; Nishimura T, 2008, INT J TUBERC LUNG D, V12, P269 ; Kobashi Y, 2008, INTERNAL MED, V47, P1957, DOI 10.2169/internalmedicine.47.1313 ; RABY E, 2008, PLOS ONE, V3, pNI529 ; Vincenti D, 2007, CLIN EXP IMMUNOL, V150, P91, DOI 10.1111/j.1365-2249.2007.03462.x ; Kang YA, 2007, CHEST, V132, P959, DOI 10.1378/chest.06-2805 ; Dheda K, 2007, J INFECTION, V55, P169, DOI 10.1016/j.jinf.2007.02.005 ; Pai M, 2007, INFECTION, V35, P98, DOI 10.1007/s15010-007-6114-z ; Menzies D, 2007, ANN INTERN MED, V146, P340 ; Dewan PK, 2007, CLIN INFECT DIS, V44, P69 ; Kobashi Y, 2006, CLIN INFECT DIS, V43, P1540 ; Lee JY, 2006, EUR RESPIR J, V28, P24, DOI 10.1183/09031936.06.00016906 ; Goletti D, 2006, CLIN MICROBIOL INFEC, V12, P544, DOI 10.1111/j.1469-0691.2006.01391.x ; Kim HJ, 2006, CHEST, V129, P1253 ; AIKEN AM, 2006, BMC INFECT DIS, V6, pNIL1 ; Kang YA, 2005, JAMA-J AM MED ASSOC, V293, P2756 ; MAZUREK GH, 2005, MMWR RECOMM REP, V54, P49 ; Carrara S, 2004, CLIN INFECT DIS, V38, P754 ; Seung KJ, 2003, INT J TUBERC LUNG D, V7, P912 ; *WHO, 2003, TREATM TUB GUID NAT, V3 ; 2000, AM J RESP CRIT CAR 2, V161, pS221 ; Foulds J, 1998, INT J TUBERC LUNG D, V2, P778 ; IM JG, 1995, CRIT REV DIAGN IMAG, V36, P227 ; COOPER AM, 1993, J EXP MED, V178, P2243 ; FLYNN JL, 1993, J EXP MED, V178, P2249 ; IM JG, 1993, RADIOLOGY, V186, P653 ; IM JG, 1991, RADIOLOGY, V178, P727 ; LANDIS JR, 1977, BIOMETRICS, V33, P159 ; APICELLA MA, 1969, J CLIN INVEST, V48, P250 ; LECKIE WJH, 1965, CLIN SCI, V29, P339 ; *WHO, GLOB TUB CONTR SURV ; 3