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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Screening for pulmonary tuberculosis in HIV-infected individuals: AIDS Clinical Trials Group Protocol A5253
International Journal of Tuberculosis and Lung Disease, Volume 17, No. 4, Year 2013
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Description
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. © 2013 The Union.
Authors & Co-Authors
Swindells, Susan N.
United States, Omaha
University of Nebraska Medical Center
Komarow, Lauren
United States, Boston
Harvard T.h. Chan School of Public Health
Tripathy, Srikanth P.
India, Pune
National Aids Research Institute India
Cain, Kevin P.
United States, Atlanta
Centers for Disease Control and Prevention
MacGregor, Rob Roy M.
United States, Philadelphia
University of Pennsylvania
Achkar, Jacqueline M.
United States, New York
Albert Einstein College of Medicine of Yeshiva University
Gupta, Amita
United States, Baltimore
Johns Hopkins University
Veloso, V. G.
Brazil, Rio de Janeiro
Instituto de Pesquisa Clínica Evandro
Asmelash, Aida
United Kingdom
Scottish Livingstone Hospital
Omoz-Oarhe, Ayotunde E.
Botswana, Gaborone
Princess Marina Hospital
Gengiah, Santhanalakshmi
South Africa, Congella
Centre for the Aids Programme of Research in South Africa
Lalloo, Umesh Gangaram
South Africa, Durban
University of Kwazulu-natal
Allen, Reena T.
United States, Silver Spring
Aids Clinical Trial Group Operations Center
Shiboski, Caroline H.
United States, San Francisco
University of California, San Francisco
Andersen, Janet W.
United States, Boston
Harvard T.h. Chan School of Public Health
Qasba, Sarojini Sonia
United States, Silver Spring
Montgomery County Health Department
Katzenstein, David A.
United States, Stanford
Stanford Healthcare
Statistics
Citations: 39
Authors: 17
Affiliations: 16
Identifiers
Doi:
10.5588/ijtld.12.0737
ISSN:
10273719
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Botswana
Malawi
South Africa
Zimbabwe
Participants Gender
Male