Screening for pulmonary tuberculosis in HIV-infected individuals: AIDS Clinical Trials Group Protocol A5253
Screening for pulmonary tuberculosis in HIV-infected individuals: AIDS Clinical Trials Group Protocol A5253
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DOI：
10.5588/ijtld.12.0737
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发表时间：
2013-04-01
影响因子：
4
通讯作者：
Katzenstein, D. K.
中科院分区：
文献类型：
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作者：
Swindells, S.;Komarow, L.;Katzenstein, D. K.
背景技术背景：人类免疫缺陷病毒（HIV）感染的patients.METHODS：一项观察性的、多国的、横断面的HIV感染患者的研究，比较标准化的诊断评估（TB）与标准治疗（SOC）。SOC评价包括TB症状审查（当前咳嗽、发热、盗汗和/或体重减轻）、痰液Ziehl-Neelsen染色和胸部X线摄影。筛查增加了扩展的临床体征和症状以及荧光显微镜检查（FM）。所有参与者均接受了所有评价。痰结核分枝杆菌培养是主要的outcome.RESULTS：共801名参与者从博茨瓦纳，马拉维，南非，津巴布韦，印度，秘鲁和巴西。中位年龄为33岁; 37%为男性，中位CD 4计数为275个细胞/mm（3）。31名参与者（4%）对Lowenstein-Jensen培养基有积极的培养，54名（8%）对MGIT有积极的培养。除一个阳性培养物外，所有阳性培养物都来自撒哈拉以南非洲，那里的结核病患病率为54/445（12%）。SOC筛查的敏感性为54%（95%CI 40-67），特异性为76%（95%CI 72-80）。阳性和阴性预测值分别为24%和92%。没有任何元素的改善SOC的预测值。结论：症状为基础的筛查与涂片显微镜检查是不够敏感。需要对艾滋病毒感染者进行更敏感的诊断检测。
BACKGROUND: Improved tuberculosis (TB) screening is urgently needed for human immunodeficiency virus (HIV) infected patients.METHODS: An observational, multi-country, cross-sectional study of HIV-infected patients to compare a standardized diagnostic evaluation (SDE) for TB with standard of care (SOC). SOC evaluations included TB symptom review (current cough, fever, night sweats and/or weight loss), sputum Ziehl-Neelsen staining and chest radiography. SDE screening added extended clinical signs and symptoms and fluorescent microscopy (FM). All participants underwent all evaluations. Mycobacterium tuberculosis on sputum culture was the primary outcome.RESULTS: A total of 801 participants were enrolled from Botswana, Malawi, South Africa, Zimbabwe, India, Peru and Brazil. The median age was 33 years; 37% were male, and median CD4 count was 275 cells/mm(3). Thirty-one participants (4%) had a positive culture on Lowenstein-Jensen media and 54 (8%) on MGIT. All but one positive culture came from sub-Saharan Africa, where the prevalence of TB was 54/445 (12%). SOC screening had 54% sensitivity (95%CI 40-67) and 76% specificity (95%CI 72-80). Positive and negative predictive values were respectively 24% and 92%. No elements of the SDE improved the predictive values of SOC.CONCLUSIONS: Symptom-based screening with smear microscopy was insufficiently sensitive. More sensitive diagnostic testing is required for HIV-infected patients.