Tuberculosis in people newly diagnosed with HIV at a large HIV care and treatment center in Northwest Cameroon: burden, comparative screening and diagnostic yields, and patient outcomes

Eyongetah Tabenyang Mbu, Florian Sauter, Alexander Zoufaly, Mark Bronsvoort, Kenton Lloyd Morgan, Jürgen Noeske, Jean-Louis Foe Abena, Melissa Sander

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Diagnosis of tuberculosis in people living with HIV is challenging due to non-specific clinical presentations and inadequately sensitive diagnostic tests. The WHO recommends screening using a clinical algorithm followed by rapid diagnosis using the Xpert MTB/RIF assay, and more information is needed to evaluate these recommendations in different settings.
Methods
From August 2012 to September 2013, consecutive adults newly diagnosed with HIV in Bamenda, Cameroon, were screened for TB regardless of symptoms by smear microscopy and culture; the Xpert MTB/RIF assay was performed retrospectively. Time to treatment and patient outcomes were obtained from routine registers.
Results
Among 1,149 people enrolled, 940 (82%) produced sputum for lab testing; of these, 68% were women, the median age was 35 years (IQR, 28-42 years), the median CD4 count was 291cells/μL (IQR, 116-496 cells/μL), and 86% had one or more of current cough, fever, night sweats, or weight loss. In total, 131 people (14%, 95% CI, 12-16%) had sputum culture-positive TB. The WHO symptom screening algorithm had a sensitivity of 92% (95%CI, 86-96%) and specificity of 15% (95%CI, 12-17%) in this population. Compared to TB culture, the sensitivity of direct smear microscopy was 25% (95% CI, 18-34%), and the sensitivity of Xpert was 68% (95% CI, 58-76); the sensitivity of both was higher for people reporting more symptoms. Only one of 69 people with smear-negative/culture-positive TB was started on TB treatment prior to culture positivity. Of 71 people with bacteriologically-confirmed TB and known outcome after 6 months, 13 (17%) had died, including 11 people with smear-negative TB and 6
people with both smear and Xpert-negative TB.
Conclusions
Use of the most sensitive rapid diagnostic test available is critical in people newly
diagnosed with HIV in this setting to maximize the detection of bacteriologicallyconfirmed
TB. However, this intervention is not sufficient alone and should be
combined with more comprehensive clinical diagnosis of TB to improve outcomes.
Original languageEnglish
Article numbere0199634
JournalPLoS ONE
Volume13
Issue number6
Early online date26 Jun 2018
DOIs
Publication statusE-pub ahead of print - 26 Jun 2018

Fingerprint Dive into the research topics of 'Tuberculosis in people newly diagnosed with HIV at a large HIV care and treatment center in Northwest Cameroon: burden, comparative screening and diagnostic yields, and patient outcomes'. Together they form a unique fingerprint.

Cite this