Screening for pulmonary tuberculosis in HIV-infected individuals: AIDS Clinical Trials Group Protocol A5253
| Autor: | 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 |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Thoracic specificity HIV Infections Cardiorespiratory Medicine and Haematology Clinical Protocols Peru Prevalence diagnostics Mass Screening Prospective Studies AIDS Clinical Trials Group 5253 Study Team Lung Microscopy screening and diagnosis Coinfection Standard of Care Pulmonary Detection Infectious Diseases tuberculosis HIV/AIDS Female Infection Algorithms Brazil 4.2 Evaluation of markers and technologies Adult Fever India Sweating Microbiology Fluorescence Rare Diseases Predictive Value of Tests Clinical Research Weight Loss Humans Africa South of the Sahara Bacteriological Techniques Prevention Sputum Mycobacterium tuberculosis HIV infection sensitivity CD4 Lymphocyte Count Radiography Cross-Sectional Studies Good Health and Well Being Cough |
| Zdroj: | The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, vol 17, iss 4 |
| Popis: | BackgroundImproved tuberculosis (TB) screening is urgently needed for human immunodeficiency virus (HIV) infected patients.MethodsAn 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.ResultsA 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.ConclusionsSymptom-based screening with smear microscopy was insufficiently sensitive. More sensitive diagnostic testing is required for HIV-infected patients. |
| Databáze: | OpenAIRE |
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