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False-Negative IGRA Pre-Anti-TNF — SCE Infectious Diseases MCQ

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HardTuberculosisFalse-Negative IGRA Pre-Anti-TNFSCE Infectious Diseases

A 42-year-old with advanced HIV infection (CD4 90 cells/mm3) has no TB symptoms but has a strong epidemiological risk of latent infection. Which initial testing approach is most consistent with NICE?

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Correct answer: B — Concurrent IGRA and Mantoux testing because severe immunocompromise can reduce test sensitivity

For severely immunocompromised adults, NICE supports concurrent IGRA and Mantoux testing rather than relying on a single immune-based test. Results must be interpreted with epidemiological risk and followed by assessment for active TB when indicated. Neither a single negative result nor postponing all assessment until immune recovery safely excludes infection.

Reference: NICE NG33: Tuberculosis: https://www.nice.org.uk/guidance/ng33/chapter/Recommendations