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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Factors Associated with Negative Direct Sputum Examination in Asian and African HIV-Infected Patients with Tuberculosis (ANRS 1260)
PLoS ONE, Volume 6, No. 6, Article e21212, Year 2011
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Description
Objective: To identify factors associated with negative direct sputum examination among African and Cambodian patients co-infected by Mycobacterium tuberculosis and HIV. Design: Prospective multicenter study (ANRS1260) conducted in Cambodia, Senegal and Central African Republic. Methods: Univariate and multivariate analyses (logistic regression) were used to identify clinical and radiological features associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensen medium. Results: Between September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB) examination was positive in sputum samples from 110 subjects (63%) and negative in 65 patients (37%). Most patients were at an advanced stage of HIV disease (92% at stage III or IV of the WHO classification) with a median CD4 cell count of 36/mm3. In this context, we found that sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR = 2.8 [95%CI:1.1-7.0]), dyspnea (OR = 2.5 [95%CI:1.1-5.6]), and localized interstitial opacities (OR = 3.1 [95%CI:1.3-7.6]), but was less frequent with CD4≤50/mm3 (OR = 0.4 [95%CI:0.2-0.90), adenopathies (OR = 0.4 [95%CI:0.2-0.93]) and cavitation (OR = 0.1 [95%CI:0.03-0.6]). Conclusions: One novel finding of this study is the association between concomitant respiratory tract infection and negative sputum AFB, particularly in Cambodia. This finding suggests that repeating AFB testing in AFB-negative patients should be conducted when broad spectrum antibiotic treatment does not lead to complete recovery from respiratory symptoms. In HIV-infected patients with a CD4 cell count below 50/mm3 without an identified cause of pneumonia, systematic AFB direct sputum examination is justified because of atypical clinical features (without cavitation) and high pulmonary mycobacterial burden. © 2011 Chartier et al.
Authors & Co-Authors
Chartier, Loïc
France, Paris
Institut Pasteur, Paris
Leng, Chanthy
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Sire, Jean Marie
Senegal, Dakar
Institut Pasteur de Dakar
Le Minor, Odile
France, Paris
Institut Pasteur, Paris
Saman, Manil
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Bercion, Raymond
Senegal, Dakar
Hopital Principal de Dakar
Rahalison, Lila
Madagascar, Antananarivo
Institut Pasteur de Madagascar
Fontanet, A. L.
France, Paris
Institut Pasteur, Paris
France, Paris
Conservatoire National Des Arts et Metiers
Germany, Yves
France, Paris
Institut Pasteur, Paris
L'Her, Pierre
France, Metz
Hôpital Militaire
Mayaud, Charles M.
France, Paris
Hôpital Tenon
Vray, Muriel M.
France, Paris
Institut Pasteur, Paris
Statistics
Citations: 12
Authors: 12
Affiliations: 8
Identifiers
Doi:
10.1371/journal.pone.0021212
e-ISSN:
19326203
Research Areas
Infectious Diseases
Study Design
Cohort Study
Study Locations
Central African Republic
Senegal