Pulmonary tuberculosis screening in anti-retroviral treated adults living with HIV in Kenya.
Pulmonary tuberculosis screening in anti-retroviral treated adults living with HIV in Kenya.
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DOI：
10.1186/s12879-021-05916-z
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发表时间：
2021-02-25
影响因子：
3.7
通讯作者：
Horne DJ
中科院分区：
文献类型：
--
作者：
Gersh JK;Barnabas RV;Matemo D;Kinuthia J;Feldman Z;Lacourse SM;Mecha J;Warr AJ;Kamene M;Horne DJ
居住在结核病高负担环境中的艾滋病病毒感染者（PLHIV）尽管接受了抗逆转录病毒治疗和异烟肼预防性治疗（IPT），仍面临患结核病的风险。世界卫生组织（WHO）针对接受抗逆转录病毒治疗的艾滋病病毒感染者的结核病症状筛查效果欠佳，需要替代的筛查策略。
我们在肯尼亚西部将艾滋病病毒阳性的成年人纳入一项前瞻性研究。未接受过IPT或在入组前6个月以上已完成IPT的个体符合条件。我们评估了总体以及按IPT状态划分的结核病患病率。我们评估了WHO症状筛查、GeneXpert MTB/RIF（Xpert）以及包括C - 反应蛋白（CRP）、血红蛋白、红细胞沉降率（ESR）和单核细胞与淋巴细胞比率在内的候选生物标志物在识别肺结核方面的准确性。一些参与者在入组6个月后接受了结核病评估。
该研究包括383名艾滋病病毒感染者，其中>99%正在接受抗逆转录病毒治疗，88%接受过IPT，入组前完成IPT的中位时间为1.1年（四分位距0.8 - 1.55年）。入组时肺结核患病率为1.3%（n = 5，95%置信区间0.4 - 3.0%）：未接受过IPT的人群中为4.3%（0.5 - 14.5%），接受过IPT治疗的参与者中为0.9%（0.2 - 2.6%）。WHO症状筛查的敏感度为0%（0 - 52%），特异度为87%（83 - 90%）。Xpert和候选生物标志物的敏感度从差到中等不等；最准确的生物标志物是CRP≥3.3mg/L（敏感度80%（28 - 100），特异度72%（67 - 77））。入组6个月后，完成IPT后肺结核的发病率为每100人年0.84例（95%置信区间，0.31 - 2.23）。
在接受IPT治疗的肯尼亚艾滋病病毒感染者中，在完成IPT后的中位1.4年时结核病患病率较低。WHO症状筛查、Xpert以及候选生物标志物在识别接受抗逆转录病毒治疗的艾滋病病毒感染者的肺结核方面不敏感。
People living with HIV (PLHIV) who reside in high tuberculosis burden settings remain at risk for tuberculosis disease despite treatment with anti-retroviral therapy and isoniazid preventive therapy (IPT). The performance of the World Health Organization (WHO) symptom screen for tuberculosis in PLHIV receiving anti-retroviral therapy is sub-optimal and alternative screening strategies are needed. We enrolled HIV-positive adults into a prospective study in western Kenya. Individuals who were IPT-naïve or had completed IPT > 6 months prior to enrollment were eligible. We evaluated tuberculosis prevalence overall and by IPT status. We assessed the accuracy of the WHO symptom screen, GeneXpert MTB/RIF (Xpert), and candidate biomarkers including C-reactive protein (CRP), hemoglobin, erythrocyte sedimentation rate (ESR), and monocyte-to-lymphocyte ratio for identifying pulmonary tuberculosis. Some participants were evaluated at 6 months post-enrollment for tuberculosis. The study included 383 PLHIV, of whom > 99% were on antiretrovirals and 88% had received IPT, completed a median of 1.1 years (IQR 0.8–1.55) prior to enrollment. The prevalence of pulmonary tuberculosis at enrollment was 1.3% (n = 5, 95% CI 0.4–3.0%): 4.3% (0.5–14.5%) among IPT-naïve and 0.9% (0.2–2.6%) among IPT-treated participants. The sensitivity of the WHO symptom screen was 0% (0–52%) and specificity 87% (83–90%). Xpert and candidate biomarkers had poor to moderate sensitivity; the most accurate biomarker was CRP ≥ 3.3 mg/L (sensitivity 80% (28–100) and specificity 72% (67–77)). Six months after enrollment, the incidence rate of pulmonary tuberculosis following IPT completion was 0.84 per 100 person-years (95% CI, 0.31–2.23). In Kenyan PLHIV treated with IPT, tuberculosis prevalence was low at a median of 1.4 years after IPT completion. WHO symptoms screening, Xpert, and candidate biomarkers were insensitive for identifying pulmonary tuberculosis in antiretroviral-treated PLHIV.
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影响因子：
3.7
作者：
Modi S;Cavanaugh JS;Shiraishi RW;Alexander HL;McCarthy KD;Burmen B;Muttai H;Heilig CM;Nakashima AK;Cain KP
通讯作者：
Cain KP
影响因子：
158.5
作者：
Danel, Christine;Moh, Raoul;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
34.3
作者：
Badje, Anani;Moh, Raoul;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
15.8
作者：
Getahun H;Kittikraisak W;Heilig CM;Corbett EL;Ayles H;Cain KP;Grant AD;Churchyard GJ;Kimerling M;Shah S;Lawn SD;Wood R;Maartens G;Granich R;Date AA;Varma JK
通讯作者：
Varma JK
DOI：
10.1080/09540121.2012.687816
发表时间：
2012-01-01
影响因子：
1.7
作者：
Kagee, Ashraf;Nel, Adriaan
通讯作者：
Nel, Adriaan