CD8⁺ T cell response in QuantiFERON-TB Gold Plus testing was associated with tuberculosis recurrence: a 2-year prospective study

Abstract

Background

Recurrence posed an important challenge to pulmonary tuberculosis (PTB) control in China. The prospective study aimed to identify potential risk factors and to explore the value of QuantiFERON-TB Gold Plus (QFT-Plus) in identifying at-risk individuals with treated prior PTB history.

Methods

All eligible individuals aged ≥18 years who had been diagnosed with PTB before 2016 in Zhongmu County, where with an average level of TB prevalence in China, were included and received baseline survey including chest radiography, QuantiFERON-TB Gold In-Tube (QFT-GIT) and QFT-Plus, then PTB recurrence was tracked through a 2-year follow-up.

Results

Half of 1068 (52.34%, 559/1068) included eligible participants were QFT-Plus positive at baseline and 21 of them recurred active TB in 2-year follow-up. Individuals aged ≥ 60 years, who had a recent history of TB and smokers were associated with increased risk of TB recurrence with an adjusted odds ratio (aOR) of 3.97 (95% confidence interval (CI): 1.29–12.24), 7.71 (95% CI: 1.74–34.25) and 4.56 (95% CI: 1.62–12.83), respectively. Compared to QFT-Plus negatives, those who were TB2+/TB1- (aOR = 15.34) exhibited stronger association with the risk of TB recurrence than those who were TB1+/TB2+ (aOR = 6.06). A dose response relationship was also found between the risk of TB recurrence with the baseline level of TB2-TB1 (p for trend < 0.001).

Conclusions

High burden of TB infection and high risk of PTB recurrence were observed in the study population. Those with recent onset of prior TB, elderly smokers and QFT-Plus positives especially with TB2 single positive deserved further attention in active TB surveillance.

Keywords:

• Tuberculosis recurrence
• history of treated prior PTB
• risk factors
• QFT-Plus
• prospective study

Acknowledgements

We thank colleagues from Zhongmu CDC, village doctors and study participants for their contributions to the study investigation.

Author Contributors

LG and QJ designed the study. WD, SP, ZL, DW and BZ organised the implement of the study. HX, LG, FS and JD did epidemiological investigation and quality control. BF, XC, LS, YH, YD and TG did IGRA test. XG and ZZ interpreted radiographs. HX and LG did data management and data analyses. LG and HX wrote the report. All authors contributed to review and revision and have seen and approved the final version of manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary material.

Additional information

Funding

This work was supported by the National Key R&D Program of China [2022YFC2303202], the CAMS Innovation Fund for Medical Sciences (CIFMS) [2021-I2M-1-037] and the National Science and Technology Major Project of China [2017ZX10201302-002]. The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.