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Smoking is a strong independent risk factor for indeterminate and false negative IGRA results

Martine G. Aabye, Morten Ruhwald, George PrayGod, Daniel Faurholt-Jepsen, Kidola Jeremiah, Maria Faurholt-Jepsen, Nyagosya Range, Henrik Friis, John Changalucha, Aase B. Andersen, Pernille Ravn
European Respiratory Journal 2011 38: 1898; DOI:
Martine G. Aabye
1Clinical Research Centre, University of Copenhagen Hvidovre Hospital, Hvidovre, Denmark
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Morten Ruhwald
1Clinical Research Centre, University of Copenhagen Hvidovre Hospital, Hvidovre, Denmark
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George PrayGod
2Mwanza Medical Centre, National Institute for Medical Research, Mwanza, Denmark
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Daniel Faurholt-Jepsen
3Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
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Kidola Jeremiah
2Mwanza Medical Centre, National Institute for Medical Research, Mwanza, Denmark
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Maria Faurholt-Jepsen
3Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
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Nyagosya Range
4Muhimbili Medical Centre, National Institute for Medical Research, Dar es Salaam, Denmark
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Henrik Friis
3Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
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John Changalucha
2Mwanza Medical Centre, National Institute for Medical Research, Mwanza, Denmark
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Aase B. Andersen
5Department of Infectious Diseases, University of Copenhagen Rigshospitalet, Copenhagen O, Denmark
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Pernille Ravn
6Department of Infectious Diseases, University of Copenhagen Herlev Hospital, Herlev, Denmark
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Abstract

Objectives: 10-40% of IGRA results are indeterminate or false negative. HIV infection, old age and immunosuppressive treatment are known risk factors, but in many cases the reason remains unknown.

The aim of this study was to identify risk factors for indeterminate and false negative TB results.

Materials and methods: 80 HIV-positive and 112 HIV-negative patients with bacteriologically confirmed pulmonary TB were included and tested with the QuantiFERON-TB (QFT-IT) and a Luminex based IP-10 test. By multivariate analysis the following parameters were tested as risk factors for an indeterminate or false negative QFT-IT or IP-10 test result: HIV-infection, age>50 years, smoking and alcohol consumption.

Results: Smokers (28/192) had a higher risk of an indeterminate or false negative result by both the QFT-IT (OR 7.1, CI: 2.2-23.0) and the IP-10 test (OR 11.2, CI: 3.3-37.8). ORs for HIV-infection was 3.6 (CI: 1.8-7.5) and 5.3 (CI: 2.2-11.8) respectively.

Antigen levels were lower in smokers for both IFN-γ (median 22 vs. 79.5 pg/ml, p<0.01) and IP-10 (median 939.4 vs. 2446.2, p<0.01).

Positivity rate (incl. indeterminate results) was lower for smokers by both the QFT-IT (50 vs. 74%, p=0.03) and the IP-10 test (42 vs. 76, p<0.01). These findings could be reproduced in HIV-positive and –negative patients individually and smoking and HIV-infection were independent risk factors (p=1.00).

Apart from HIV-infection no other parameter tested was identified as a risk factor for a false negative or indeterminate result by either test.

Conclusion: Smoking increases the risk of having a false negative or indeterminate IGRA results. IGRA test results should be interpreted with care in smokers.

  • © 2011 ERS
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Smoking is a strong independent risk factor for indeterminate and false negative IGRA results
Martine G. Aabye, Morten Ruhwald, George PrayGod, Daniel Faurholt-Jepsen, Kidola Jeremiah, Maria Faurholt-Jepsen, Nyagosya Range, Henrik Friis, John Changalucha, Aase B. Andersen, Pernille Ravn
European Respiratory Journal Sep 2011, 38 (Suppl 55) 1898;

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Smoking is a strong independent risk factor for indeterminate and false negative IGRA results
Martine G. Aabye, Morten Ruhwald, George PrayGod, Daniel Faurholt-Jepsen, Kidola Jeremiah, Maria Faurholt-Jepsen, Nyagosya Range, Henrik Friis, John Changalucha, Aase B. Andersen, Pernille Ravn
European Respiratory Journal Sep 2011, 38 (Suppl 55) 1898;
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