Basis for treatment of tuberculosis among HIV-infected patients in Tanzania: the role of chest x-ray and sputum culture

BMC Infect Dis. 2008 Mar 6;8:32. doi: 10.1186/1471-2334-8-32.

Abstract

Background: Active tuberculosis (TB) is common among HIV-infected persons living in tuberculosis endemic countries, and screening for tuberculosis (TB) is recommended routinely. We sought to determine the role of chest x-ray and sputum culture in the decision to treat for presumptive TB using active case finding in a large cohort of HIV-infected patients.

Methods: Ambulatory HIV-positive subjects with CD4 counts > or = 200/mm3 entering a Phase III TB vaccine study in Tanzania were screened for TB with a physical examination, standard interview, CD4 count, chest x-ray (CXR), blood culture for TB, and three sputum samples for acid fast bacillus (AFB) smear and culture.

Results: Among 1176 subjects 136 (12%) were treated for presumptive TB. These patients were more frequently male than those without treatment (34% vs. 25%, respectively; p = 0.049) and had lower median CD4 counts (319/microL vs. 425/microL, respectively; p < .0001). Among the 136 patients treated for TB, 38 (28%) had microbiologic confirmation, including 13 (10%) who had a normal CXR and no symptoms. There were 58 (43%) treated patients in whom the only positive finding was an abnormal CXR. Blood cultures were negative in all patients.

Conclusion: Many ambulatory HIV-infected patients with CD4 counts > or = 200/mm3 are treated for presumptive TB. Our data suggest that optimal detection requires comprehensive evaluation, including CXR and sputum culture on both symptomatic and asymptomatic subjects.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antitubercular Agents / therapeutic use
  • Benzophenoneidum
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Diagnosis, Differential
  • Female
  • HIV Infections / complications*
  • HIV Infections / immunology
  • HIV*
  • Humans
  • Male
  • Mass Chest X-Ray
  • Microbiological Techniques / methods
  • Microscopy / methods
  • Mycobacterium tuberculosis / isolation & purification
  • Rhodamines
  • Sensitivity and Specificity
  • Sputum / microbiology*
  • Tanzania / epidemiology
  • Tuberculosis / complications
  • Tuberculosis / diagnosis*
  • Tuberculosis / drug therapy
  • Tuberculosis / prevention & control

Substances

  • Antitubercular Agents
  • Rhodamines
  • Benzophenoneidum