Predictive value of anemia for tuberculosis in HIV-infected patients in Sub-Saharan Africa: an indication for routine microbiological investigation using new rapid assays.
Predictive value of anemia for tuberculosis in HIV-infected patients in Sub-Saharan Africa: an indication for routine microbiological investigation using new rapid assays.
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DOI：
10.1097/qai.0000000000000091
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发表时间：
2014-05-01
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影响因子：
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通讯作者：
Lawn SD
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作者：
Kerkhoff AD;Wood R;Vogt M;Lawn SD
撒哈拉以南非洲艾滋病毒感染者贫血与未确诊结核病之间的关系尚未完全确定。我们评估了艾滋病毒相关贫血患者中结核病的患病率，并评估了结核病快速诊断的新方法。在南非开普敦的抗逆转录病毒治疗（ART）初治患者中测量血液血红蛋白水平，并根据WHO标准对贫血进行分类。通过使用液体培养（参考标准）、荧光显微镜和Xpert MTB/RIF检测配对痰液样本，筛查所有患者的TB。使用Determine TB-LAM诊断测定法检测尿液样品中的脂阿拉伯甘露聚糖（LAM）。在602名接受筛查的成年人中，485人获得了完整的结果。44.5%（n=216）的患者血红蛋白水平正常，24.9%（n=121）、25.4%（n=123）和5.2%（n=25）的患者分别存在轻度、中度或重度贫血。在无贫血的患者中，8.8%（19/216）的患者被诊断为培养确诊的肺结核，而轻度、中度或重度贫血患者分别为16.5%（20/121）、26.0%（32/123）和40.0%（10/25）（p<0.001）。贫血是结核病的一个强有力的独立预测因子。与无/轻度贫血的患者相比，使用痰液显微镜检查（42.9% vs 15.4%）、尿LAM（54.8% vs 0%）、痰液显微镜检查+尿LAM（71.4% vs 15.4%）和痰液Xpert（73.8% vs 41.0%）进行诊断检测的灵敏度在中度/重度贫血患者中高得多（均P<0.01）。在中度或重度贫血患者中，未确诊的结核病发病率很高。应优先对此类患者进行常规微生物检查，使用快速诊断测定法。
The relationship between anaemia and undiagnosed tuberculosis (TB) in patients living with HIV in sub-Saharan Africa is incompletely defined. We assessed the prevalence of TB among those with HIV-related anaemia and evaluated new means of rapid TB diagnosis. Blood haemoglobin levels were measured in unselected antiretroviral treatment (ART)-naïve patients in Cape Town, South Africa, and anaemia was classified according to WHO criteria. All patients were screened for TB by testing paired sputum samples using liquid culture (reference standard), fluorescence microscopy and Xpert MTB/RIF. Urine samples were tested for lipoarabinomannan (LAM) using the Determine TB-LAM diagnostic assay. Of 602 adults screened, 485 had complete results. Normal haemoglobin levels were found in 44.5% (n=216) of patients and mild, moderate or severe anaemia were present in 24.9% (n=121), 25.4% (n=123) and 5.2% (n=25) of patients, respectively. Culture-confirmed pulmonary TB was diagnosed in 8.8% (19/216) of those without anaemia compared to 16.5% (20/121), 26.0% (32/123) and 40.0% (10/25) with mild, moderate or severe anaemia, respectively (p<0.001). Anaemia was a strong independent predictor of TB. The sensitivities of diagnostic assays were much higher among those with moderate/severe anaemia compared to those with no/mild anaemia using sputum microscopy (42.9% vs 15.4%); urine LAM (54.8% vs 0%); sputum microscopy plus urine LAM (71.4% vs 15.4%) and sputum Xpert (73.8% vs 41.0%) (P<0.01 for all). A very high prevalence of undiagnosed TB was found in patients with moderate or severe anaemia. Such patients should be prioritized for routine microbiological investigation using rapid diagnostic assays.