Objective We sought to determine the accuracy and role of rapid C-reactive protein (CRP) testing in HIV-infected tuberculosis suspects. Design We enrolled HIV-infected adults (≥18 years) with a cough for ≥2 weeks and negative sputum smears for acid-fast bacilli (AFB) in KwaZulu-Natal, South Africa. Participants were evaluated for pulmonary tuberculosis by a nurse with rapid CRP, and independently by a physician with a chest radiograph. Rapid CRP test results were compared to laboratory CRP and sputum sent for confirmation of tuberculosis. Results Among 93 participants, 55 (59%) were female, mean age was 35 years, and median CD4 count was 177/mm3. Forty-five (54%) participants were diagnosed with pulmonary tuberculosis. Diagnostic sensitivity and specificity were 95% (95% CI 74–99%) and 51% (95% CI 35–66%) for rapid CRP > 8 mg/l, 87% (95% CI 73–96%) and 53% (95% CI 38–68%) for nurse assessment, and 69% (95% CI 52–83%) and 76% (95%CI 61–87%) for physician examination. Combining a positive rapid CRP (> 8 mg/l) to nurse and physician assessments decreased post- test probability of pulmonary tuberculosis from 22% to 6% and 32% to 6%, respectively. Conclusion Rapid CRP testing helped exclude pulmonary tuberculosis, and may be a valuable test to assist nurses and physicians in tuberculosis-endemic regions.
Background Sutherlandia frutescens (L.) R. Br. is widely used as an over the counter complementary medicine and in traditional medications by HIV seropositive adults living in South Africa; however the plant’s safety has not been objectively studied. An adaptive two-stage randomized double-blind placebo controlled study was used to evaluate the safety of consuming dried S. frutescens by HIV seropositive adults with CD4 T-lymphocyte count of >350 cells/μL.MethodsIn Stage 1 56 participants were randomized to S. frutescens 400, 800 or 1,200 mg twice daily or matching placebo for 24 weeks. In Stage 2 77 additional participants were randomized to either 1,200 mg S. frutescens or placebo. In the final analysis data from Stage 1 and Stage 2 were combined such that 107 participants were analysed (54 in the S. frutescens 1,200 mg arm and 53 in the placebo arm).Results S. frutescens did not change HIV viral load, and CD4 T-lymphocyte count was similar in the two arms at 24 weeks; however, mean and total burden of infection (BOI; defined as days of infection-related events in each participant) was greater in the S. frutescens arm: mean (SD) 5.0 (5.5) vs. 9.0 (12.7) days (p = 0.045), attributed to two tuberculosis cases in subjects taking isoniazid preventive therapy (IPT).ConclusionA possible interaction between S. frutescens and IPT needs further evaluation, and may presage antagonistic interactions with other herbs having similar biochemical (antioxidant) properties. No other safety issues relating to consumption of S. frutescens in this cohort were identified.Trial RegistrationClinicalTrials.gov NCT00549523
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