Screening for pulmonary tuberculosis in HIV-infected individuals

AIDS Clinical Trials Group Protocol A5253

S. Swindells, L. Komarow, S. Tripathy, K. P. Cain, R. R. MacGregor, Jacqueline M. Achkar, A. Gupta, V. G. Veloso, A. Asmelash, A. E. Omoz-Oarhe, S. Gengiah, U. Lalloo, R. Allen, C. Shiboski, J. Andersen, S. S. Qasba, D. K. Katzenstein

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

BACKGROUND: Improved tuberculosis (TB) screening is urgently needed for human immunodeficiency virus (HIV) infected patients. METHODS: An observational, multi-country, crosssectional 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. RESULTS: A 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/mm3. 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. CONCLUSIONS: Symptom-based screening with smear microscopy was insufficiently sensitive. More sensitive diagnostic testing is required for HIV-infected patients.

Original languageEnglish (US)
Pages (from-to)532-539
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Volume17
Issue number4
DOIs
StatePublished - Apr 1 2013

Fingerprint

Clinical Protocols
Pulmonary Tuberculosis
Standard of Care
Acquired Immunodeficiency Syndrome
Clinical Trials
HIV
Tuberculosis
Sputum
Microscopy
Botswana
Malawi
Zimbabwe
Peru
Sweat
Africa South of the Sahara
CD4 Lymphocyte Count
South Africa
Mycobacterium tuberculosis
Cough
Radiography

Keywords

  • Diagnostics
  • HIV infection
  • Sensitivity
  • Specificity
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Screening for pulmonary tuberculosis in HIV-infected individuals : AIDS Clinical Trials Group Protocol A5253. / Swindells, S.; Komarow, L.; Tripathy, S.; Cain, K. P.; MacGregor, R. R.; Achkar, Jacqueline M.; Gupta, A.; Veloso, V. G.; Asmelash, A.; Omoz-Oarhe, A. E.; Gengiah, S.; Lalloo, U.; Allen, R.; Shiboski, C.; Andersen, J.; Qasba, S. S.; Katzenstein, D. K.

In: International Journal of Tuberculosis and Lung Disease, Vol. 17, No. 4, 01.04.2013, p. 532-539.

Research output: Contribution to journalArticle

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 2013, 'Screening for pulmonary tuberculosis in HIV-infected individuals: AIDS Clinical Trials Group Protocol A5253', International Journal of Tuberculosis and Lung Disease, vol. 17, no. 4, pp. 532-539. https://doi.org/10.5588/ijtld.12.0737
Swindells, S. ; Komarow, L. ; Tripathy, S. ; Cain, K. P. ; MacGregor, R. R. ; Achkar, Jacqueline M. ; Gupta, A. ; Veloso, V. G. ; Asmelash, A. ; Omoz-Oarhe, A. E. ; Gengiah, S. ; Lalloo, U. ; Allen, R. ; Shiboski, C. ; Andersen, J. ; Qasba, S. S. ; Katzenstein, D. K. / Screening for pulmonary tuberculosis in HIV-infected individuals : AIDS Clinical Trials Group Protocol A5253. In: International Journal of Tuberculosis and Lung Disease. 2013 ; Vol. 17, No. 4. pp. 532-539.
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AU - Cain, K. P.

AU - MacGregor, R. R.

AU - Achkar, Jacqueline M.

AU - Gupta, A.

AU - Veloso, V. G.

AU - Asmelash, A.

AU - Omoz-Oarhe, A. E.

AU - Gengiah, S.

AU - Lalloo, U.

AU - Allen, R.

AU - Shiboski, C.

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AU - Katzenstein, D. K.

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N2 - BACKGROUND: Improved tuberculosis (TB) screening is urgently needed for human immunodeficiency virus (HIV) infected patients. METHODS: An observational, multi-country, crosssectional 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. RESULTS: A 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/mm3. 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. CONCLUSIONS: Symptom-based screening with smear microscopy was insufficiently sensitive. More sensitive diagnostic testing is required for HIV-infected patients.

AB - BACKGROUND: Improved tuberculosis (TB) screening is urgently needed for human immunodeficiency virus (HIV) infected patients. METHODS: An observational, multi-country, crosssectional 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. RESULTS: A 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/mm3. 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. CONCLUSIONS: Symptom-based screening with smear microscopy was insufficiently sensitive. More sensitive diagnostic testing is required for HIV-infected patients.

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KW - Sensitivity

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