Screening for pulmonary tuberculosis in HIV-infected individuals: AIDS Clinical Trials Group Protocol A5253.
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Author list: Swindells S, Komarow L, Tripathy S, Cain KP, MacGregor RR, Achkar JM, Gupta A, Veloso VG, Asmelash A, Omoz-Oarhe AE, Gengiah S, Lalloo U, Allen R, Shiboski C, Andersen J, Qasba SS, Katzenstein DK, AIDS Clinical Trials Group 5253 Study Team
Publisher: International Union Against Tuberculosis and Lung Disease
Publication year: 2013
Journal: International Journal of Tuberculosis and Lung Disease (1027-3719)
Journal acronym: Int J Tuberc Lung Dis
Volume number: 17
Issue number: 4
Start page: 532
End page: 9
Number of pages: -522
ISSN: 1027-3719
eISSN: 1815-7920
Languages: English-Great Britain (EN-GB)
Abstract
BACKGROUND\nMETHODS\nRESULTS\nCONCLUSIONS\nImproved tuberculosis (TB) screening is urgently needed for human immunodeficiency virus (HIV) infected patients.\nAn observational, multi-country, cross-sectional study of HIV-infected patients to compare a standardized diagnostic evaluation (SDE) for TB with standard of care (SOC). SOC evaluations included TB symptom review (current cough, fever, night sweats and/or weight loss), sputum Ziehl-Neelsen staining and chest radiography. SDE screening added extended clinical signs and symptoms and fluorescent microscopy (FM). All participants underwent all evaluations. Mycobacterium tuberculosis on sputum culture was the primary outcome.\nA total of 801 participants were enrolled from Botswana, Malawi, South Africa, Zimbabwe, India, Peru and Brazil. The median age was 33 years; 37% were male, and median CD4 count was 275 cells/mm(3). Thirty-one participants (4%) had a positive culture on Löwenstein-Jensen media and 54 (8%) on MGIT. All but one positive culture came from sub-Saharan Africa, where the prevalence of TB was 54/445 (12%). SOC screening had 54% sensitivity (95%CI 40-67) and 76% specificity (95%CI 72-80). Positive and negative predictive values were respectively 24% and 92%. No elements of the SDE improved the predictive values of SOC.\nSymptom-based screening with smear microscopy was insufficiently sensitive. More sensitive diagnostic testing is required for HIV-infected patients.
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