RESUMO
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 Löwenstein-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.
Assuntos
Coinfecção , Infecções por HIV/diagnóstico , Programas de Rastreamento , Tuberculose Pulmonar/diagnóstico , Adulto , África Subsaariana/epidemiologia , Algoritmos , Técnicas Bacteriológicas , Brasil/epidemiologia , Contagem de Linfócito CD4 , Protocolos Clínicos , Tosse/microbiologia , Estudos Transversais , Feminino , Febre/microbiologia , Infecções por HIV/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Programas de Rastreamento/métodos , Microscopia de Fluorescência , Mycobacterium tuberculosis/isolamento & purificação , Peru/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Radiografia Torácica , Escarro/microbiologia , Padrão de Cuidado , Sudorese , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Redução de PesoRESUMO
The diversity of human immunodeficiency virus type 1 (HIV-1) has given rise to multiple subtypes and recombinant strains. The majority of research into antiretroviral agents and drug resistance has been performed on subtype B viruses, yet non-subtype B strains are responsible for 90% of global infections. Although it seems that combination antiretroviral regimens are effective against all HIV-1 subtypes, there is emerging evidence of subtype differences in drug resistance, relevant to antiretroviral strategies in different parts of the world. For this purpose, extensive sampling of HIV genetic diversity, curation and analyses are required to inform antiretroviral strategies in different parts of the world.