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

Muhammad Bakari, Robert D Arbeit, Lillian Mtei, Johnson Lyimo, Richard Waddell, Mecky Matee, Bernard F Cole, Susan Tvaroha, C Robert Horsburgh, Hanna Soini, Kisali Pallangyo, C Fordham von Reyn, Muhammad Bakari, Robert D Arbeit, Lillian Mtei, Johnson Lyimo, Richard Waddell, Mecky Matee, Bernard F Cole, Susan Tvaroha, C Robert Horsburgh, Hanna Soini, Kisali Pallangyo, C Fordham von Reyn

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.

Figures

Figure 1
Figure 1
Basis for TB treatment in HIV-infected subjects with CD4 counts ≥ 200/mm3. Sputum microbiology was positive in 1 patient with symptoms, 10 with abnormal chest x-ray and 14 with both findings. See Table 2 for details.

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Source: PubMed

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