Point-of-care C-reactive protein-based tuberculosis screening for people living with HIV: a diagnostic accuracy study.
Point-of-care C-reactive protein-based tuberculosis screening for people living with HIV: a diagnostic accuracy study.
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DOI：
10.1016/s1473-3099(17)30488-7
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发表时间：
2017-12
期刊：
影响因子：
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通讯作者：
Cattamanchi A
中科院分区：
文献类型：
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作者：
Yoon C;Semitala FC;Atuhumuza E;Katende J;Mwebe S;Asege L;Armstrong DT;Andama AO;Dowdy DW;Davis JL;Huang L;Kamya M;Cattamanchi A
建议对所有艾滋病毒携带者(PLHIV)进行基于症状的结核病筛查，从而导致居住在结核病流行区的绝大多数人进行不必要的结核分枝杆菌/RIF检测，从而使强化病例发现(ICF)和结核病预防治疗的实施不力。因此，新的结核病筛查方法对于实现全球消除结核病的目标至关重要。在乌干达两家艾滋病毒/艾滋病诊所进行的一项前瞻性研究中，我们评估了C反应蛋白(≤)作为活动性肺结核筛查工具的性能，该研究采用了一种快速且廉价的护理点(POC)分析方法。在1 177名HIV感染者(CD_4~+T细胞计数中位数168个/微米L)入选患者中，163人(14%)经培养确诊为结核病。POC-CRP对培养确认结核的敏感性为89%(145/163)，特异性为72%(731/1014)。与世界卫生组织症状筛查相比，POC-CRP的敏感性较低(差值−为7%[95%CI：−12至−2]，p=0.002)，但特异度显著较高(差值+58%[95%CI：+61至+55]，p<；0.0001)。以Xpert MTB/RIF结果为参考标准，POC-CRP与WHO症状筛查的敏感性相似(94%[79/84]对99%[83/84]；差值−为5%[95%CI：−12 to+2]，p=0.10)。C反应蛋白的性能特点支持将其用作人类免疫缺陷病毒的结核病筛查测试，并启动了≤350细胞/L的抗逆转录病毒治疗。HIV/AIDS项目应考虑基于POC-CRP的结核病筛查，以提高ICF的效率并增加结核病预防治疗的接受度。美国国立卫生研究院；总统艾滋病紧急救援计划；加州大学旧金山分校，尼娜·爱尔兰肺部健康项目
Symptom-based screening for tuberculosis (TB) is recommended for all people living with HIV (PLHIV) resulting in unnecessary Xpert MTB/RIF testing for the vast majority of individuals living in TB endemic areas and thus, poor implementation of intensified case finding (ICF) and TB preventive therapy. Novel approaches to TB screening are therefore critical in achieving global targets for TB elimination. In a prospective study of PLHIV with CD4+ T-cell count ≤350 cells/uL initiating antiretroviral therapy (ART) from two HIV/AIDS clinics in Uganda, we evaluated the performance of C-reactive protein (CRP) measured using a rapid and inexpensive point-of-care (POC) assay as a screening tool for active pulmonary TB. Of 1177 HIV-infected adults (median CD4+ T-cell count 168 cells/µL) enrolled, 163 (14%) had culture-confirmed TB. POC CRP had 89% (145/163) sensitivity and 72% (731/1014) specificity for culture-confirmed TB. Compared to the WHO symptom screen, POC CRP had lower sensitivity (difference −7% [95% CI: −12 to −2], p=0.002) but substantially higher specificity (difference +58% [95% CI: +61 to +55], p<0.0001). When Xpert MTB/RIF results were used as the reference standard, sensitivity of POC CRP and the WHO symptom screen were similar (94% [79/84] vs. 99% [83/84]; difference −5% [95% CI: −12 to +2], p=0.10). The performance characteristics of CRP support its use as a TB screening test for PLHIV with CD4+ T-cell count ≤350 cells/µL initiating ART. HIV/AIDS programs should consider POC CRP-based TB screening to improve the efficiency of ICF and increase uptake of TB preventive therapy. National Institutes of Health; Presidential Emergency Plan for AIDS Relief; University of California, San Francisco, Nina Ireland Program for Lung Health