• Jason R Andrews, Mark Hatherill, Hassan Mahomed, Willem A Hanekom, Monica Campo, Thomas R Hawn, Robin Wood, and Thomas J Scriba.
• 1 Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California.
• Am. J. Respir. Crit. Care Med. 2015 Mar 1; 191 (5): 584591584-91.

RationaleInterferon-γ release assays are used to diagnose tuberculosis infection. In developed countries, high rates of reversion following conversion have been described.ObjectivesTo assess QuantiFERON TB Gold In-Tube test (QFT) conversion and reversion dynamics in a tuberculosis-endemic setting.MethodsAdolescents aged 12-18 years residing near Cape Town were recruited. Tuberculin skin tests (TSTs) and QFTs were performed at baseline and after 2 years of follow up. Half of the participants had TST and QFT performed at additional time points. Participants were observed for incident tuberculosis disease for up to 5 years.Measurements And Main ResultsAmong 5,357 participants, 2,751 (51.4%) and 2,987 (55.8%) had positive QFT and TST results, respectively, at baseline. Annualized QFT and TST conversion risks were 14.0 and 13.0%, respectively, and reversion risks were 5.1 and 4.1%, respectively. Concordance was excellent for conversions (κ = 0.74), but poor for reversions (κ = 0.12). Among recent QFT converters, the magnitude of the QFT value was strongly inversely associated with risk of reversion (P < 0.0001). When longitudinal QFT data were analyzed in a cross-sectional manner, the annual risk of infection was 7.3%, whereas inclusion of reversions in the analysis showed that the actual risk of infection was 14.0%. Incident tuberculosis was 8-fold higher among QFT reverters than in participants with all negative QFT results (1.47 vs. 0.18 cases/100 person-years, P = 0.011).ConclusionsIn this tuberculosis-endemic setting, annual risk of infection was extremely high, whereas QFT and TST conversion concordance was higher and QFT reversion rates were lower than reported in low-burden settings.

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