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Treatment decisions and mortality in HIV-positive presumptive smear-negative TB in the Xpertâ„¢ MTB/RIF era: a cohort study
- Source :
- BMC Infectious Diseases, BMC Infectious Diseases, Vol 17, Iss 1, Pp 1-8 (2017), BMC infectious diseases, 17(1). BioMed Central, BMC infectious diseases
- Publication Year :
- 2017
-
Abstract
- Background: The Xpert (TM) MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for TB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV co-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a routine care setting is unclear. We determined the change in diagnosis, treatment and mortality of smear-negative presumptive TB with routine use of Xpert MTB/RIF (XP). Methods: Prospective cohort study of HIV-positive smear-negative presumptive TB patients during a 12-month period after XP implementation in a well-staffed and trained integrated TB/HIV clinic in Kampala, Uganda. Prior to testing clinicians were asked to decide whether they would treat empirically prior to Xpert result; actual treatment was decided upon receipt of the XP result. We compared empirical and XP-informed treatment decisions and all-cause mortality in the first year. Results: Of 411 smear-negative presumptive TB patients, 175 (43%) received an XP; their baseline characteristics did not differ. XP positivity was similar in patients with a pre-XP empirical diagnosis and those without (9/29 [17%] versus 14/142 [10%], P = 0.23). Despite XP testing high levels of empirical treatment prevailed (18%), although XP results did change who ultimately was treated for TB. When adjusted for CD4 count, empirical treatment was not associated with higher mortality compared to no or microbiologically confirmed treatment. Conclusions: XP usage was lower than expected. The lower sensitivity of XP in smear-negative HIV-positive patients led experienced clinicians to use XP as a "rule-in" rather than "rule-out" test, with the majority of patients still treated empirically.
- Subjects :
- Adult
Male
medicine.medical_specialty
Tuberculosis
030231 tropical medicine
HIV Infections
HIV Infections/complications
Sensitivity and Specificity
lcsh:Infectious and parasitic diseases
Mycobacterium tuberculosis
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Medical microbiology
Internal medicine
medicine
Humans
Molecular diagnostic techniques/methods
lcsh:RC109-216
Uganda
030212 general & internal medicine
Prospective Studies
Prospective cohort study
Empirical treatment
Microscopy
biology
business.industry
Coinfection
Tuberculosis, pulmonary/epidemiology
Sputum
medicine.disease
biology.organism_classification
3. Good health
Surgery
CD4 Lymphocyte Count
Infectious Diseases
Molecular Diagnostic Techniques
Tropical medicine
Female
Human medicine
medicine.symptom
business
Tuberculosis, pulmonary/diagnosis
Cohort study
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 14712334
- Volume :
- 17
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC infectious diseases
- Accession number :
- edsair.doi.dedup.....36808cd2b5acb1641ddfb0189500da62