Subclinical tuberculosis among adults with HIV: clinical features and outcomes in a South African cohort

Bajema, Kristina L.; Bassett, Ingrid V.; Coleman, S. M.; Ross, Douglas S.; Freedberg, Kenneth A.; Wald, Anna; Drain, Paul K.

doi:10.1186/s12879-018-3614-7

Cited by 28 publications

(25 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results we report for TB symptom prevalence (with cough also being the most common symptom reported) and percentage of patients with TB symptoms tested for TB reported in our study are consistent with what has been previously published at a national level in Kenya 13 and in HIV study cohorts in South Africa. [14][15][16][17][18][19][20][21] The consistency of our estimates of TB disease prevalence with previously published literature varied. Some studies report estimates that were comparable, 13 14 lower 15 or higher.…”

Section: Discussionsupporting

confidence: 64%

See 1 more Smart Citation

Prevalence of TB symptoms, diagnosis and treatment among people living with HIV (PLHIV) not on ART presenting at outpatient clinics in South Africa and Kenya: baseline results from a clinical trial

et al. 2020

View full text Add to dashboard Cite

ObjectiveWe used screening data and routine clinic records for intervention arm patients in the Simplified Algorithm for Treatment Eligibility (SLATE) trials to describe the prevalence of tuberculosis (TB) symptoms, diagnosis and treatment among people living with HIV (PLHIV), not on antiretroviral therapy (ART) and presenting at outpatient clinics in South Africa and Kenya. We compared the performance of the WHO four-symptom TB screening tool with a baseline Xpert test.SettingOutpatient HIV clinics in South Africa and Kenya.ParticipantsEligible patients were non-pregnant, PLHIV, >18 years of age, not on ART, willing to provide written informed consent. A total of 594 patients in South Africa and 240 in Kenya were eligible.ResultsPrevalence of any TB symptom was 38% in Kenya, 35% (SLATE I) and 47% (SLATE II) in South Africa. During SLATE I, 70% of patients in Kenya and 57% in South Africa with ≥1 TB symptom were tested for TB. In SLATE II, 79% of patients with ≥1 TB symptom were tested. Of those, 19% tested positive for TB in Kenya, 15% (SLATE I) and 5% (SLATE II) tested positive in South Africa. Of the 28 patients who tested positive in both trials, 20 initiated TB treatment. The lowest median CD4 counts were among those with active TB (Kenya 124 cells/mm3; South Africa 193 cells/mm3). When comparing the WHO four-symptom screening tool to the Xpert test (SLATE II), we found that increasing the number of symptoms required for a positive screen from one to three or four decreased sensitivity but increased the positive predictive value to >30%.Conclusions80% of patients assessed for ART initiation presented with ≥1 TB symptoms. Reconsideration of the ‘any symptom’ rule may be appropriate, with ART initiation among patients with fewer/milder symptoms commencing while TB test results are pending.Trial registration numberNCT02891135 and NCT03315013.

show abstract

Section: Discussionsupporting

confidence: 64%

“…Some studies report estimates that were comparable, 13 14 lower 15 or higher. [16][17][18][19][20][21] National estimates of TB prevalence are still sparse in South Africa. However, the National Tuberculosis Prevalence Survey is currently underway is currently underway in South Africa, so better estimates will be available soon.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of TB symptoms, diagnosis and treatment among people living with HIV (PLHIV) not on ART presenting at outpatient clinics in South Africa and Kenya: baseline results from a clinical trial

et al. 2020

View full text Add to dashboard Cite

show abstract

“…This was one of the first and largest studies to evaluate the clinical characteristics of subclinical TB in an intermediate TB burden country with a low prevalence of human immunodeficiency virus (HIV) infection [ 14 ]. Bajema et al [ 15 ] conducted a prospective study enrolling HIV-infected adults in South Africa and found that the prevalence of subclinical TB disease was common, accounting for 23% of all TB cases, and its mortality rate was similar with patients without TB. In our cohort, the prevalence of subclinical TB was 19.2%.…”

Section: Discussionmentioning

confidence: 99%

Clinical profiles of subclinical disease among pulmonary tuberculosis patients: a prospective cohort study in South Korea

et al. 2020

View full text Add to dashboard Cite

Background Subclinical tuberculosis (TB) is a potential target for public health intervention because its early identification may reduce TB transmission. We aimed to describe the clinical and laboratory findings of subclinical disease among pulmonary TB patients and compared treatment outcomes for subclinical and active diseases. Methods In this prospective cohort study, we enrolled adult patients aged ≥ 19 years with pulmonary TB between 2016 and 2018. Subclinical TB was defined as radiographic or microbiologic test results consistent with TB without clinical symptoms. We implemented a two-stage symptom assessment using a predefined TB symptom checklist. Demographic, clinical, and laboratory data were compared between subclinical and active diseases using multivariable binary logistic regression analysis. We evaluated treatment outcomes in the drug-susceptible cohort. Results Among 420 enrolled patients, 81 (19.3%) had subclinical TB. Multivariable analysis showed that age < 65 years was the only variable significantly associated with subclinical disease. Subclinical disease had a significantly lower proportion of acid-fast bacilli smear and culture positivity and multiple lobe involvement compared to active disease. The white blood cell counts, platelet counts, and C-reactive protein levels were significantly higher among patients with active disease than among those with subclinical disease. Among 319 patients with treatment success in the drug-susceptible cohort, six (1.9%) recurrent cases were identified, and all were active disease. Patients with subclinical disease had a higher proportion of favourable outcomes; however, its odds ratio was insignificant. Conclusions Nearly one-fifth of tuberculosis cases were subclinical in South Korea. Despite its milder clinical presentation and lower level of inflammatory markers, the treatment outcomes of subclinical TB were not significantly different from that of active disease.

show abstract

“…This was one of the rst and largest studies to evaluate the clinical characteristics of subclinical TB in an intermediate TB burden country with a low prevalence of human immunode ciency virus (HIV) infection [14]. Bajema et al conducted a prospective study enrolling HIV-infected adults in South Africa and found that the prevalence of subclinical TB disease was common, accounting for 23% of all TB cases, and its mortality rate was similar with patients without TB [15]. In our cohort, the prevalence of subclinical TB was 19.2%.…”

Section: Discussionmentioning

confidence: 99%

Clinical profiles of subclinical disease among pulmonary tuberculosis patients: a prospective cohort study in South Korea

Min

Chung

Jung

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Subclinical tuberculosis (TB) is a potential target for public health intervention because its early identification may reduce TB transmission. We aimed to describe the clinical and laboratory findings of subclinical disease among pulmonary TB patients and compared treatment outcomes for subclinical and active diseases.Methods: In this prospective cohort study, we enrolled adult patients aged ≥19 years with pulmonary TB between 2016 and 2018. Subclinical TB was defined as radiographic or microbiologic test results consistent with TB without clinical symptoms. We implemented a two-stage symptom assessment using a predefined TB symptom checklist. Demographic, clinical, and laboratory data were compared between subclinical and active diseases using multivariate binary logistic regression analysis. We evaluated treatment outcomes in the drug-susceptible cohort. Results: Among 420 enrolled patients, 81 (19.3%) had subclinical TB. Multivariate analysis showed that age <65 years was the only variable significantly associated with subclinical disease. Subclinical disease had a significantly lower proportion of acid-fast bacilli smear and culture positivity and multiple lobe involvement compared to active disease. The white blood cell counts, platelet counts, and C-reactive protein levels were significantly higher among patients with active disease than among those with subclinical disease. Among 319 patients with treatment success in the drug-susceptible cohort, six (1.9%) recurrent cases were identified, and all were active disease. Patients with subclinical disease had a higher proportion of favourable outcomes; however, its odds ratio was insignificant.Conclusions: Nearly one-fifth of tuberculosis cases were subclinical in South Korea. Despite its milder clinical presentation and lower level of inflammatory markers, the treatment outcomes of subclinical TB were not significantly different from that of active disease.

show abstract

Subclinical tuberculosis among adults with HIV: clinical features and outcomes in a South African cohort

Cited by 28 publications

References 29 publications

Prevalence of TB symptoms, diagnosis and treatment among people living with HIV (PLHIV) not on ART presenting at outpatient clinics in South Africa and Kenya: baseline results from a clinical trial

Prevalence of TB symptoms, diagnosis and treatment among people living with HIV (PLHIV) not on ART presenting at outpatient clinics in South Africa and Kenya: baseline results from a clinical trial

Clinical profiles of subclinical disease among pulmonary tuberculosis patients: a prospective cohort study in South Korea

Clinical profiles of subclinical disease among pulmonary tuberculosis patients: a prospective cohort study in South Korea

Contact Info

Product

Resources

About