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What is the clinical utility of interferon-α release assays for the diagnosis of TB in high-TB-burden countries?

Peter Daley and Poorvi Chordia

The advent of interferon-γ release assays (IGRAs) has provided a new insight into the diagnosis and immunology of TB. IGRAs are being widely accepted and marketed in low-TB-burden countries. However, globally, the impact of TB is concentrated in 22 high-burden countries, where high percentages of the population are infected with TB, HIV coinfection rates are high, continuous community TB exposure occurs, laboratory infrastructure is weak and latent TB infection is not treated. What role do these new assays play in these settings? Can they really have an important benefit in these countries, among people who most need an innovation in TB diagnostics? Here, we examine the most current literature in order to answer specific diagnostic questions that are relevant to these settings.