Diagnosis of Tuberculosis in HIV Co‐infected Individuals: Current Status, Challenges and Opportunities for the Future

Abstract

Tuberculosis (TB) remains one of the most important causes of death among people co-infected with human immunodeficiency virus (HIV). The diagnosis of TB remains challenging in HIV co-infected individuals, due to a high frequency of smear-negative disease and high rates of extrapulmonary TB. Accurate, ease of use and rapid diagnosis of active TB are critical to the World Health Organization (WHO) End TB Strategy by 2050. Traditional laboratory techniques do not provide rapid and accurate results to effectively manage HIV co-infected patients. Over the last decade, molecular methods have provided significant steps in the fight against TB. However, many HIV co-infected patients do not have access to these molecular diagnostic tests. Given the costs closely related with confirming a TB diagnosis in HIV patients, an overtreatment for TB is used in this patient population. Nowadays, an estimated US $8 billion a year is required to provide TB treatment, which is very high compared with making an important strategy to improve the current diagnostic tests. This review focuses on current advances in diagnosing active TB with an emphasis on the diagnosis of HIV-associated TB. Also discussed are the main challenges that need to be overcome for improving an adequate initial diagnosis of active TB in HIV-positive patients.

Comparison of different bacteriological testing strategies and factors for bacteriological confirmation among pulmonary TB patients: a retrospective study in Tianjin, China, 2017-2018

“…Apart from factors relating to laboratory, patients with speci c characteristics tend to have pauci-bacillary, such as HIV co-infection, children, and mild clinical manifestations. [17][18][19] Generally, more severe and complex condition tend to cause bacteriological positivity. Cavitation on chest X-ray usually means enriched bacteria in the lesion and represents later stage of the disease, and cough can produce sputum containing MTB from the lesion to the air through droplets, increasing the possibility to detect MTB in sputum samples, which is in consistent with previous studies.…”

The diagnostic performance of TB-IGRA on HIV infected patients with active tuberculosis is associated with CD4+ T-cell counts

“…TB is the leading cause of death among patients co-infected with HIV. And due to a high frequency of smear-negative and high rates of extrapulmonary TB in HIV co-infected people, TB is di cult to diagnostic in these patients [12]. In the past two decades, the immune diagnosis of MTB infection provided more rapid and accurate results than traditional laboratory techniques in the ght against TB.…”

The diagnostic performance of TB-IGRA on HIV infected patients with active tuberculosis is associated with CD4+ T-cell counts

“…Tuberculosis is the leading cause of death among patients co-infected with HIV. And due to a high frequency of smear-negative and high rates of extrapulmonary TB in HIV co-infected people, it is difficult for diagnosis of TB [12]. In the past two decades, the immune diagnosis of Mycobacterium tuberculosis infection provided rapid and accurate results than traditional laboratory techniques in the fight against TB.…”