Diagnostic Performance of Interferon-γ Release Assay combined with Xpert MTB/RIF for Pulmonary Tuberculosis in AIDS Patients with Low CD<sub>4</sub><sup>+</sup> T Lymphocyte Counts

Yue ZHAO; Can LIU; Yawei CAO; Yingying ZHANG

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Yue ZHAO, Can LIU, Yawei CAO, Yingying ZHANG. Diagnostic Performance of Interferon-γ Release Assay combined with Xpert MTB/RIF for Pulmonary Tuberculosis in AIDS Patients with Low CD4+ T Lymphocyte Counts[J]. Journal of Kunming Medical University.

Citation:

Yue ZHAO, Can LIU, Yawei CAO, Yingying ZHANG. Diagnostic Performance of Interferon-γ Release Assay combined with Xpert MTB/RIF for Pulmonary Tuberculosis in AIDS Patients with Low CD₄⁺ T Lymphocyte Counts[J]. Journal of Kunming Medical University.

Citation:

Yue ZHAO, Can LIU, Yawei CAO, Yingying ZHANG. Diagnostic Performance of Interferon-γ Release Assay combined with Xpert MTB/RIF for Pulmonary Tuberculosis in AIDS Patients with Low CD₄⁺ T Lymphocyte Counts[J]. Journal of Kunming Medical University.

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Diagnostic Performance of Interferon-γ Release Assay combined with Xpert MTB/RIF for Pulmonary Tuberculosis in AIDS Patients with Low CD₄⁺ T Lymphocyte Counts

1.
General Medicine，Hengshui Second People’s Hospital，Hengshui Hebei 053000
2.
Respiratory Medicine，Hengshui Third People’s Hospital，Hengshui Hebei 053000，China

Received Date: 2025-08-06
Available Online: 2026-01-24

Abstract

Abstract

Objective To evaluate the clinical efficacy of interferon-γ （ IFN-γ ） release assay （ IGRA ） combined with real-time fluorescence quantitative nucleic acid amplification assay （ Xpert MTB / RIF ） in the diagnosis of pulmonary tuberculosis in AIDS patients with low CD₄⁺T lymphocyte counts. Methods A total of 140 AIDS patients with low CD₄⁺T counts admitted to Hengshui Second People's Hospital from January 2023 to January 2025 were selected as the research subjects. Based on PTB status, patients were divided into a non-tuberculosis group （26 cases without tuberculosis）, a bacteria-negative group （68 cases with bacteria-negative tuberculosis）, and a bacteria-positive group （46 cases with bacteria-positive tuberculosis）. Blood IFN-γ levels were compared among the three groups, and the detection rates of IGRA, Xpert MTB/RIF, and their combination were analyzed. Baseline characteristics were compared between IGRA-negative and IGRA-positive patients. Patients were further stratified into three subgroups based on CD4+ T-cell count: <50 cells/μL, 50-99 cells/μL, and 100～199 cells/μL. Detection rates of the three diagnostic strategies were compared across subgroups. Agreement between each diagnostic strategy and the final clinical diagnosis was assessed. ROC curve was used to analyze the diagnostic value of each strategy for patients with different CD₄⁺T lymphocyte count levels. Result The detection rates of IGRA, Xpert MTB/RIF and their combination were significantly lower in the non-TB group compared to those in the negative bacteria group and the positive bacteria group （P < 0.05）. The mycobacterial culture positivity rate was higher in the positive bacteria group than that in the non-tuberculosis group and the negative group （P < 0.05）. Among the 68 patients with negative pulmonary tuberculosis, 68 （100.00%） had positive pathological findings. The IGRA-positive group was younger （P < 0.05） and had a higher proportion of patients with symptom duration <1 month compared to the IGRA-negative group （P < 0.05）. The detection rates of IGRA, Xpert MTB/RIF and their combination were significantly lower in the <50 cells/μL subgroup compared to the 50-99 cells/μL and 100-199 cells/μL subgroups（P < 0.05）.In AIDS patients with PTB and CD4+ T-cell counts of 50–99 cells/μL or 100–199 cells/μL, all three diagnostic strategies showed good agreement with the clinical diagnosis （Kappa ≥ 0.75）. For patients with counts <50 cells/μL, agreement was moderate （0.4 ≤ Kappa < 0.75）. Conclusion The diagnostic accuracy of IGRA combined with Xpert MTB/RIF may be superior to either test alone. Diagnostic accuracy decreases with declining CD4+ T-cell counts, yet the combined approach may retain a relative advantage.

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