Improving Tuberculosis Case Finding in Persons Living with Advanced HIV through New Diagnostic Algorithms

Martínez, Leonardo; Andrews, Jason R.

doi:10.1164/rccm.201809-1702ed

Cited by 5 publications

(6 citation statements)

References 13 publications

(12 reference statements)

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“…Further evaluation of the cost effectiveness of new diagnostic algorithms (including symptom screening, point-of-care C-reactive protein, Determine TB-LAM, Xpert MTB/RIF Ultra, and culture) to improve TB case detection while controlling costs at PEFPAR clinical sites is warranted. 47 …”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021

Ganesan

Mwesigwa

Dear

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021

Ganesan

Mwesigwa

Dear

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…The WHO recommends ACF with a preliminary symptom screen followed by confirmatory testing to exclude TB among people living with HIV [24]. This strategy has been limited in part by a low specificity of symptom screening leading to a large number needed to test and consequent laboratory burden [3, 25, 26]. Our results found a comparable sensitivity (93%) and specificity (41%) of the WHO recommended symptom screen as compared to studies outside EE, and our study is one of the first studies providing data in the region [3].…”

Section: Discussionmentioning

confidence: 99%

High Yield of Active Tuberculosis Case Finding Among HIV-Infected Patients Using Xpert MTB/RIF Testing

Kempker

Chkhartishvili

Kinkladze

et al. 2019

Open Forum Infectious Diseases

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Objective Conduct an active case finding study in Tbilisi, Georgia, for pulmonary tuberculosis (TB) among people living with HIV (PLWH). Methods Newly diagnosed HIV patients were assessed for symptoms and asked to submit sputum samples for smear microscopy, culture, and molecular diagnostic testing (Xpert MTB/RIF). Results Among 276 PLWH, 131 agreed to participate and 103 submitted sputum samples. Most participants were male (70%) and mean age of 43 years. There were high rates of a positive hepatitis C virus (HCV) antibody test (46%) and the median CD4 count was 122 cells/mm3. A total of 15 (11.5%) persons were diagnosed with pulmonary TB, including 1 each with multidrug-resistant and isoniazid-resistant disease. Twelve had a positive culture for Mycobacterium tuberculosis and Xpert TB/RIF assay, and 4 had positive smear microscopy. Patients with pulmonary TB were more likely to use injection drugs (67% vs 36%, P = .02) and have a positive HCV antibody (73% vs 42%, P = .02). The presence and absence of any TB symptom had a sensitivity and negative predictive value for TB of 93% and 98%, respectively. Conclusion Our findings highlight the high prevalence of TB among newly diagnosed HIV-infected patients in an area with high rates of drug-resistant TB and the utility of an active case finding strategy for TB diagnosis.

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“…The case finding (ICF) algorithm recommended by the WHO for PLWH consists of symptom-based screening followed by confirmatory testing using Xpert MTB/rifampicin (RIF) for all individuals who screen positive. [ 15 ] The algorithm can exclude TB through symptom screening, but it is difficult to apply to resource-constrained areas with a high incidence of TB because of its high cost. Yoon et al [ 12 ] proposed a novel ICF algorithm based on CRP combined with TB-LAM of urine, Xpert of sputum, or sputum culture.…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and treatment of tuberculosis in adults with HIV

Yang¹,

Han²,

Shen³

et al. 2022

Medicine

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Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), continues to pose a major public health problem and is the leading cause of mortality in people infected with human immunodeficiency virus (HIV). HIV infection greatly increases the risk of developing TB even before CD4+ T-cell counts decrease. Co-infection provides reciprocal advantages to both pathogens and leads to acceleration of both diseases. In HIV-coinfected persons, the diagnosis and treatment of tuberculosis are particularly challenging. Intensifying integration of HIV and tuberculosis control programmes has an impact on reducing diagnostic delays, increasing early case detection, providing prompt treatment onset, and ultimately reducing transmission. In this Review, we describe our current understanding of how these two pathogens interact with each other, new sensitive rapid assays for TB, several new prevention methods, new drugs and regimens. Abbreviations: ART = antiretroviral therapy, CRP = C-reactive protein, CYP3A = cytochrome p450 3A, GM-CSF = granulocytemacrophage colony-stimulating factor, HDT = host-directed therapy, HIV = human immunodeficiency virus, ICF = The case finding, INH = isoniazid, IPT = isoniazid preventive therapy, LAM = lipoarabinomannan, LF-LAM = lateral flow lipoarabinomannan, MDR-TB = multidrug-resistant tuberculosis, MDSCs = myeloid-derived suppressor cells, MTB = Mycobacterium tuberculosis, PLWH = people with HIV, QFT = QuantiFERON Gold In-Tube, RIF = rifampicin, Se NPs = selenium nanoparticles, TB = tuberculosis, TB-IRIS = tuberculosis-associated immune reconstitution inflammatory syndrome, TPT = tuberculosis preventive therapy, TSPOT = T.SPOT-TB, TST = TB skin test, XDR-TB = extensively drug-resistant tuberculosis.

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Improving Tuberculosis Case Finding in Persons Living with Advanced HIV through New Diagnostic Algorithms

Cited by 5 publications

References 13 publications

Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021

Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021

High Yield of Active Tuberculosis Case Finding Among HIV-Infected Patients Using Xpert MTB/RIF Testing

Diagnosis and treatment of tuberculosis in adults with HIV

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