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Acid-fast microscopy was performed on all samples submitted for mycobacterial culture with PCR PI3K inhibitor performed selectively according to national guidelines [1]. As microscopy is not specific for Mycobacterium tuberculosis and the number of samples on which PCR was performed is low, comparative data against these parameters would not be statistically valid. Hence, IGRA results are compared with mycobacterial culture, the reference standard for the laboratory diagnosis of TB, and to clinically diagnosed highly probable cases of TB disease. Tuberculin skin tests were not routinely performed and therefore not included in the analysis. From 415 QFT-GIT requested, 120 were excluded from further analysis (28 insufficient data, 19 duplicate tests, 20 clinically indeterminate cases, 53 asymptomatic screening cases). From the remaining 295 symptomatic Lapatinib mw patients 42 had culture-positive TB, 21 had culture-negative TB and 232 had an alternative diagnosis. Overall, 53% were male patients; median age was 40?years; 55% were of UK origin, 20% were from Africa, 19% were from the Indian subcontinent, 3% were from the Middle East, and 2% and 1% were from other Asian and other European countries, respectively; 17% were HIV-positive with a median CD4 count of 329?cells/��L (range 28�C1060) (Table?1). Forty-six (73%) of those with TB had EPTB, 9 (14%) had PTB, 7 (11%) had mixed PTB and EPTB and 1 (2%) had miliary TB. HIV +ve (%) Median CD4 (range) 51 (17) 329 (28�C1060) 14 (22) 261 (93�C891) 37 (16) 350 (28�C1060) For the diagnosis of active TB disease the overall sensitivity of QFT-GIT was 71.4% (95% CI 59.3�C81.1), specificity was 81.0% (95% CI 75.5�C85.6) and NPV was 92.6% (95% CI 88.2�C95.5). No significant difference in sensitivity was seen in culture-positive TB (76.2% (95% CI 61.5�C86.5)) compared with culture-negative TB (61.9% (95% CI 40.9�C79.3)) or in PTB (75.0% (95% CI 50.5�C89.8)) compared with EPTB (71.7% (95% CI 58.4�C82.0)). Specificity and NPV were significantly higher in patients of UK origin compared with those of non-UK S6 Kinase origin (89.3% (95% CI 83.3�C93.3) and 97.1% (95% CI 92.7�C98.9) versus 66.3% (95% CI 55.6�C75.5) and 83.3% (95% CI 72.6�C90.4)) (Table?2). In all HIV-infected patients the sensitivity of QFT-GIT was 71.4% (95% CI 45.4�C88.3), specificity was 81.1% (95% CI 65.8�C90.5) and NPV was 90.9% (95% CI 76.4�C96.9) for the diagnosis of active TB disease. There was no significant difference in the performance of the assay in patients with CD4 counts of