Bibliographic information
Recommendation
interferon-gamma release assays tuberculosis interferon-gamma release assays (IGRAs) (and the TST) should not be used in low- and middle-income countries for the diagnosis of pulmonary or extra-pulmonary TB, nor for the diagnostic work-up of adults (including HIV-positive individuals) suspected of active TB in these settings (strong recommendation). This recommendation places a high value on avoiding the consequences of unnecessary treatment (high false-positives) given the low specificity of tuberculosis interferon-gamma release assays (IGRAs) (and the TST) in these settings.
Recommended against
Strong
Certainty of evidence
Very low
Notes and Remarks
The Guideline Development Group concluded that both the sensitivity and specificity of IGRAs in detecting active TB among individuals presumed of having TB were suboptimal and the quality of evidence was low. They also recommended that these tests not be used as a replacement for conventional microbiological diagnosis of pulmonary and extrapulmonary TB. The Guideline Development Group noted that current evidence did not support the use of IGRAs or the TST as part of the diagnostic work-up of adults presumed of active TB, irrespective of HIV status. This recommendation placed a high value on avoiding the consequences of unnecessary treatment (owing to a high number of false positive results), given the low specificity of IGRAs and the TST in these settings.
Also Featured In
This recommendation also appears in the following guidelines:
WHO consolidated guidelines on tuberculosis: module 3: diagnosis: tests for TB infection