Subclinical tuberculosis among adults with HIV: clinical features and outcomes in a South African cohort

Kristina L Bajema, Ingrid V Bassett, Sharon M Coleman, Douglas Ross, Kenneth A Freedberg, Anna Wald, Paul K Drain, Kristina L Bajema, Ingrid V Bassett, Sharon M Coleman, Douglas Ross, Kenneth A Freedberg, Anna Wald, Paul K Drain

Abstract

Background: Subclinical tuberculosis is an asymptomatic disease phase with important relevance to persons living with HIV. We describe the prevalence, clinical characteristics, and risk of mortality for HIV-infected adults with subclinical tuberculosis.

Methods: Untreated adults with HIV presenting for outpatient care in Durban, South Africa were screened for tuberculosis-related symptoms and had sputum tested by acid-fast bacilli smear and tuberculosis culture. Active tuberculosis and subclinical tuberculosis were defined as having any tuberculosis symptom or no tuberculosis symptoms with culture-positive sputum. We evaluated the association between tuberculosis disease category and 12-month survival using Cox regression, adjusting for age, sex, and CD4 count.

Results: Among 654 participants, 96 were diagnosed with active tuberculosis disease and 28 with subclinical disease. The median CD4 count was 68 (interquartile range 39-161) cells/mm3 in patients with active tuberculosis, 136 (72-312) cells/mm3 in patients with subclinical disease, and 249 (125-394) cells/mm3 in those without tuberculosis disease (P < 0.001). The proportion of smear positive cases did not differ significantly between the subclinical (29%) and active tuberculosis groups (14%, P 0.08). Risk of mortality was not increased in individuals with subclinical tuberculosis relative to no tuberculosis (adjusted hazard ratio 0.84, 95% confidence interval 0.26-2.73).

Conclusions: Nearly one-quarter of tuberculosis cases among HIV-infected adults were subclinical, which was characterized by an intermediate degree of immunosuppression. Although there was no significant difference in survival, anti-tuberculous treatment of subclinical cases was common.

Trial registration: Prospectively registered on ClinicalTrials.gov , NCT01188941 (August 26, 2010).

Keywords: AIDS-related opportunistic infections; Disease progression; HIV; Subclinical infections; Tuberculosis.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the McCord Hospital Medical Research Ethics Committee, St. Mary’s Hospital Medical Research Ethics Committee, the University of KwaZulu-Natal Biomedical Research Ethics Committee, Partners Institutional Review Board, and the University of Washington Human Subjects Division. All participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan Meier survival curves of adults with HIV stratified by tuberculosis status

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