Tuberculosis in people newly diagnosed with HIV at a large HIV care and treatment center in Northwest Cameroon: Burden, comparative screening and diagnostic yields, and patient outcomes

Mbu, Eyongetah Tabenyang, Sauter, Florian, Zoufaly, Alexander, Bronsvoort, Barend M de C, Morgan, Kenton L, Noeske, Jurgen, Abena, Jean-Louis Foe and Sander, Melissa S (2018) Tuberculosis in people newly diagnosed with HIV at a large HIV care and treatment center in Northwest Cameroon: Burden, comparative screening and diagnostic yields, and patient outcomes. PLOS ONE, 13 (6). e0199634-.

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Official URL: http://dx.doi.org/10.1371/journal.pone.0199634

Abstract

<h4>Background</h4>Diagnosis of tuberculosis in people living with HIV is challenging due to non-specific clinical presentations and inadequately sensitive diagnostic tests. The WHO recommends screening using a clinical algorithm followed by rapid diagnosis using the Xpert MTB/RIF assay, and more information is needed to evaluate these recommendations in different settings.<h4>Methods</h4>From August 2012 to September 2013, consecutive adults newly diagnosed with HIV in Bamenda, Cameroon, were screened for TB regardless of symptoms by smear microscopy and culture; the Xpert MTB/RIF assay was performed retrospectively. Time to treatment and patient outcomes were obtained from routine registers.<h4>Results</h4>Among 1,149 people enrolled, 940 (82%) produced sputum for lab testing; of these, 68% were women, the median age was 35 years (IQR, 28-42 years), the median CD4 count was 291cells/μL (IQR, 116-496 cells/μL), and 86% had one or more of current cough, fever, night sweats, or weight loss. In total, 131 people (14%, 95% CI, 12-16%) had sputum culture-positive TB. The WHO symptom screening algorithm had a sensitivity of 92% (95%CI, 86-96%) and specificity of 15% (95%CI, 12-17%) in this population. Compared to TB culture, the sensitivity of direct smear microscopy was 25% (95% CI, 18-34%), and the sensitivity of Xpert was 68% (95% CI, 58-76); the sensitivity of both was higher for people reporting more symptoms. Only one of 69 people with smear-negative/culture-positive TB was started on TB treatment prior to culture positivity. Of 71 people with bacteriologically-confirmed TB and known outcome after 6 months, 13 (17%) had died, including 11 people with smear-negative TB and 6 people with both smear and Xpert-negative TB.<h4>Conclusions</h4>Use of the most sensitive rapid diagnostic test available is critical in people newly diagnosed with HIV in this setting to maximize the detection of bacteriologically-confirmed TB. However, this intervention is not sufficient alone and should be combined with more comprehensive clinical diagnosis of TB to improve outcomes.

Item Type:	Article
Uncontrolled Keywords:	Humans, Tuberculosis, HIV Infections, Prevalence, Retrospective Studies, Follow-Up Studies, Adult, Cameroon, Female, Male
Depositing User:	Symplectic Admin
Date Deposited:	16 May 2019 07:46
Last Modified:	19 Jan 2023 00:45
DOI:	10.1371/journal.pone.0199634
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3041445