![]() In the longer term, basic research is necessary to identify highly predictive biomarkers. Such high-risk individuals may be identifiable by using multivariable risk prediction models that incorporate test results with risk factors and using serial testing to resolve underlying phenotypes. To maximize the positive predictive value of existing tests, LTBI screening should be reserved for those who are at sufficiently high risk of progressing to disease. Both TST and IGRA have reduced sensitivity in immunocompromised patients and have low predictive value for progression to active TB. ![]() Neither test can accurately differentiate between LTBI and active TB, distinguish reactivation from reinfection, or resolve the various stages within the spectrum of M. They represent indirect markers of Mycobacterium tuberculosis exposure and indicate a cellular immune response to M. ![]() Evidence suggests that both TST and IGRA are acceptable but imperfect tests. Two tests are available for identification of LTBI: the tuberculin skin test (TST) and the gamma interferon (IFN-γ) release assay (IGRA). However, there is no diagnostic gold standard for LTBI. Identification and treatment of latent tuberculosis infection (LTBI) can substantially reduce the risk of developing active disease.
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