High yield of active tuberculosis case finding among HIV-infected patients using xpert MTB/RIF testing

• Type of Material: Article
• Authors: Russell Ryan Kempker, Emory University; Nikoloz Chkhartishvili, Infectious Diseases, AIDS, and Clinical Immunology Research Center; Inga Kinkladze, National Center for Tuberculosis and Lung Diseases; Marcos C Schechter, Emory University; Kristin Harrington, Emory University; Nino Rukhadze, Infectious Diseases, AIDS, and Clinical Immunology Research Center; Lela Dzigua, Infectious Diseases, AIDS, and Clinical Immunology Research Center; Tengiz Tserstvadze, Infectious Diseases, AIDS, and Clinical Immunology Research Center; Carlos Del Rio, Emory University; Henry Michael Blumberg, Emory University; Nestani Tukvadze, National Center for Tuberculosis and Lung Diseases
• Language: English
• Date: 2019-06-03
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2019.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofz233
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 6
• Issue: 6
• Start Page: ofz233
• End Page: ofz233
• Grant/Funding Information: This work has been supported by the National Institutes of Health Fogarty International Center (D43TW007124); the National Institute of Allergy and Infectious Diseases (K23AI103044; R21AI122001); the Atlanta Clinical and Translational Science Institute (UL1TR000454); the Center for AIDs Research at Emory University (P30AI050409); and the Emory Global Health Institute.
• Keywords: TB symptoms; Georgia; Tbilisi; Case finding
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Objective. Conduct an active case finding study in Tbilisi, Georgia, for pulmonary tuberculosis (TB) among people living with HIV (PLWH). Methods. Newly diagnosed HIV patients were assessed for symptoms and asked to submit sputum samples for smear microscopy, culture, and molecular diagnostic testing (Xpert MTB/RIF). Results. Among 276 PLWH, 131 agreed to participate and 103 submitted sputum samples. Most participants were male (70%) and mean age of 43 years. There were high rates of a positive hepatitis C virus (HCV) antibody test (46%) and the median CD4 count was 122 cells/mm3. A total of 15 (11.5%) persons were diagnosed with pulmonary TB, including 1 each with multidrug-resistant and isoniazid-resistant disease. Twelve had a positive culture for Mycobacterium tuberculosis and Xpert TB/RIF assay, and 4 had positive smear microscopy. Patients with pulmonary TB were more likely to use injection drugs (67% vs 36%, P = .02) and have a positive HCV antibody (73% vs 42%, P = .02). The presence and absence of any TB symptom had a sensitivity and negative predictive value for TB of 93% and 98%, respectively. Conclusion. Our findings highlight the high prevalence of TB among newly diagnosed HIV-infected patients in an area with high rates of drug-resistant TB and the utility of an active case finding strategy for TB diagnosis.