TY - JOUR
T1 - Pregnancy differentially impacts performance of latent tuberculosis diagnostics in a high-burden setting
AU - Mathad, Jyoti S.
AU - Bhosale, Ramesh
AU - Sangar, Vikrant
AU - Mave, Vidya
AU - Gupte, Nikhil
AU - Kanade, Savita
AU - Nangude, Ashwini
AU - Chopade, Kavita
AU - Suryavanshi, Nishi
AU - Deshpande, Prasad
AU - Kulkarni, Vandana
AU - Glesby, Marshall J.
AU - Fitzgerald, Daniel
AU - Bharadwaj, Renu
AU - Sambarey, Pradeep
AU - Gupta, Amita
N1 - Funding Information:
All authors have read and approved the revised manuscript, have met the criteria for authorship as established by the International Committee of Medical Journal Editors, and are able to verify the validity of the results reported. As stated previously, AG has received funding from the Gilead Foundation and the World Health Organization. JSM has received a travel grant from the Infectious Diseases Society of America. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. All other authors have declared that no competing interests exist.
PY - 2014/3/21
Y1 - 2014/3/21
N2 - Background: Targeted screening for latent TB infection (LTBI) in vulnerable populations is a recommended TB control strategy. Pregnant women are at high risk for developing TB and likely to access healthcare, making pregnancy an important screening opportunity in developing countries. The sensitivity of the widely-used tuberculin skin test (TST), however, may be reduced during pregnancy. Methods: We performed a cross-sectional study comparing the TST with the QuantiFERON Gold In-tube (QGIT) in 401 HIVnegative women presenting antepartum (n = 154), at delivery (n = 148), or postpartum (n = 99) to a government hospital in Pune, India. A subset of 60 women enrolled during pregnancy was followed longitudinally and received both tests at all three stages of pregnancy. Results: The QGIT returned significantly more positive results than the TST. Of the 401 women in the cross-sectional study, 150 (37%) had a positive QGIT, compared to 59 (14%) for the TST (p<0.005). Forty-nine (12%) did not have their TST read. Of 356 who had both results available, 46 (13%) were concordant positive, 91 (25%) were discordant (12 (3%) TST+/QGIT-; 79 (22%) TST-/QGIT+), and 206 (57%) concordant negative. Comparison by stage of pregnancy revealed that QGIT percent positivity remained stable between antepartum and delivery, unlike TST results (QGIT 31-32% vs TST 11-17%). Median IFN-γ concentration was lower at delivery than in antepartum or postpartum (1.66 vs 2.65 vs 8.99 IU/mL, p = 0.001). During postpartum, both tests had significantly increased positives (QGIT 31% vs 32% vs 52%, p = 0.01; TST 17% vs 11% vs 25%, p<0.005). The same trends were observed in the longitudinal subset. Conclusions: Timing and choice of LTBI test during pregnancy impact results. QGIT was more stable and more closely approximated the LTBI prevalence in India. But pregnancy stage clearly affects both tests, raising important questions about how the complex immune changes brought on by pregnancy may impact LTBI screening.
AB - Background: Targeted screening for latent TB infection (LTBI) in vulnerable populations is a recommended TB control strategy. Pregnant women are at high risk for developing TB and likely to access healthcare, making pregnancy an important screening opportunity in developing countries. The sensitivity of the widely-used tuberculin skin test (TST), however, may be reduced during pregnancy. Methods: We performed a cross-sectional study comparing the TST with the QuantiFERON Gold In-tube (QGIT) in 401 HIVnegative women presenting antepartum (n = 154), at delivery (n = 148), or postpartum (n = 99) to a government hospital in Pune, India. A subset of 60 women enrolled during pregnancy was followed longitudinally and received both tests at all three stages of pregnancy. Results: The QGIT returned significantly more positive results than the TST. Of the 401 women in the cross-sectional study, 150 (37%) had a positive QGIT, compared to 59 (14%) for the TST (p<0.005). Forty-nine (12%) did not have their TST read. Of 356 who had both results available, 46 (13%) were concordant positive, 91 (25%) were discordant (12 (3%) TST+/QGIT-; 79 (22%) TST-/QGIT+), and 206 (57%) concordant negative. Comparison by stage of pregnancy revealed that QGIT percent positivity remained stable between antepartum and delivery, unlike TST results (QGIT 31-32% vs TST 11-17%). Median IFN-γ concentration was lower at delivery than in antepartum or postpartum (1.66 vs 2.65 vs 8.99 IU/mL, p = 0.001). During postpartum, both tests had significantly increased positives (QGIT 31% vs 32% vs 52%, p = 0.01; TST 17% vs 11% vs 25%, p<0.005). The same trends were observed in the longitudinal subset. Conclusions: Timing and choice of LTBI test during pregnancy impact results. QGIT was more stable and more closely approximated the LTBI prevalence in India. But pregnancy stage clearly affects both tests, raising important questions about how the complex immune changes brought on by pregnancy may impact LTBI screening.
UR - https://www.scopus.com/pages/publications/84899092782
UR - https://www.scopus.com/pages/publications/84899092782#tab=citedBy
U2 - 10.1371/journal.pone.0092308
DO - 10.1371/journal.pone.0092308
M3 - Article
C2 - 24658103
AN - SCOPUS:84899092782
SN - 1932-6203
VL - 9
JO - PloS one
JF - PloS one
IS - 3
M1 - e92308
ER -