High Performance of Systematic Combined Urine Liboarabinomannan Test and Sputum Xpert MTB/RIF for Tuberculosis Screening in Severely Immunosuppressed Ambulatory Adults With Human Immunodeficiency Virus
Author:
Bonnet Maryline1ORCID, Gabillard Delphine2, Domoua Serge3, Muzoora Conrad4, Messou Eugène5, Sovannarith Samreth6, Nguyen Duc Bang7, Badje Anani25, Juchet Sylvain5, Bunnet Dim8, Borand Laurence89, Natukunda Naome10, Tran Thị Hong7, Anglaret Xavier2, Laureillard Didier1112, Blanc François-Xavier13, Aka Kakou, Aoussi Eba, Bissagnene Emmanuel, Eholié Serge, Ello Frédéric, Nzunetu Gustave, Rabe Cyprien, Sidibé Baba, Adjé Florence, Ahonou Boris, Amani Jacqueline, Anzian Amani, Assoua Anicet, Ayemou Lucien, Diomandé Glao, Etilé Etienne, Gnokoro Joachim, Goli Jeannot, Gouesse Patrice, Kati-Coulibaly Loukou, Konan Lambert, Konan Edwige, Kouadio Francis, Kouakou Martial, Kouamé Aristide, Labibi Georgette, Lathro Marie Cécile, Nogbout Marie-Pascale, N’Dry Lucie, Tchehy Amah, Zadi Ida, Ahiboh Hugues, Emieme Arlette, Inwoley André, Kabran Mathieu, Menan Hervé, Ouassa Timothée, Toni Thomas-d’Aquin, N’Guessan Raymond, Aboua Adrienne, Ahyi Irmine, Cissé Adoulaye, Danel Christine, Konan Allé Baba DiengRomuald, N’Chot Célestin, Koffi Larissa N’Guessan, Konan Sylvie, Kouadio Suzanne, Menan Gérard, Moh Raoul, Siloué Bertine, Yao-Yapi Cyril, Aheisibwe Hillary, Arinaitwe Rinah, Atuhaire Syson, Kesande Claire, Isaac Isaac Ampaire, Kajabwangu Rodgers, Kyasiimire Stella, Kyarimpa Rose, Mpeirwe Doreen, Mugabirwe Gaudioza, Nansumba Margret, Natukunda Eva, Namubiru Teddy, Nakanwagi Masturah, Nkeramahame Junenal, Nyangoma Miria, Tayebwa Colman, Orikiriza Patrick, Mugisha Ivan Taremwa, Turyashemererwa Esther, Nanjebe Deborah, Turuho Thadeous, Nalusaji Aisha, Ayabare Arnold, Kabanda Ronald, Kassaza Kennedy, Muwanga and Sulaiman, Mean Chi Vun, Ly Penh Sun, Chea Daly, Mom Chandara, Pich Sophana, Sar Sandap, Bun Vannary, Chan Kuong, Chhneang Virin, Chhum Chheng Kong, Khiev Samnang, Sreng Setha Lim, Long Nary, Ly Makara, Ma Suon Sopheak, Mao Kimcolin, Men Panharoat, Mol Sovannary, Nhem Vandoeun, Nin Navy, Roeun Moeung, So Manith, Sok Phal, Song Sovannara, Sos Mary, Sotheara , Thim , Uk Narith, Um Sokha, Mao Tan Eang, Yanith Che, Chim Socheat, Chum Bun Than, Dara Doung, Din Chanthy, Eng Panha, Hang Putheary, Im Savorn, Keath Huy, Keo Karona, Khem Sok Lida, Lay Phirum, Leng Phalla, Oeung Chiv Hun, Ouk Kalyan, Pe Reaksmey, Phe Thong, Phoung Bunthy, Rouen Mono, San Sok Leang, Sek Sophy, Sina Teav, Srey Pichsovannary, Sun Seakly, Thai Sopheak, Veng Chhun Heng, Suntouch Young, Cheng Sokleaph, Heng Seiha, Kerléguer Alexandra, Hek Morina, Him Brembrey, Keo Monorea, Nang Boraneath, Suom Sophea, Thaan Sreymom, City Ho Chi Minh, Dang Le Minh Tri, Lam Quoc Dung, Le Hong Ngoc, Nguyen Thi Hieu, Nguyen Thi Hong, Nguyen Huu Minh, Nguyen Van Song, Nguyen Ha Uyen, Nguyen Nhu Viet, Nguyen Thi Bich Yen, Pham Thi Tuong Vy, Tran Ngoc Thach, Tran Pham Phuong Thao, To My Huong, Nguyen Huu Lân, Anh Thi Quynh, Nguyen , Pham Hung Cuong, Nguyen Thi Thuy Nga, Quach Kim Ung, Tieu Thi Thu Van, Nguyen Ngoc Lan, Nguyen Thi Cao Van, Tran Huu Loc, Vu Xuan Thinh, Huynh Khanh Thu, Luong Que Anh, Truong Thi Xuan Lien, Dinh Thi Thanh, Domergue Anaïs, Guiroy Frédérique, Le Quoc Khanh, Rapoud Delphine, Tran Thi Hai Ly, Carrou Jérôme Le, Karcher Sophie, Clouet Gwenaëlle, Lawn Stephen D,
Affiliation:
1. University of Montpellier, TransVIH MI, Institut de Recherche pour le Développement (IRD) , Inserm, Montpellier , France 2. IRD, Inserm, University of Bordeaux , France 3. Pneumology Department, Félix Houphouët-Boigny University , Abidjan, Côte d’Ivoire 4. Internal Medicine Department, Mbarara University of Science and Technology , Mbarara , Uganda 5. PAC-CI , Abidjan , Côte d’Ivoire 6. National Centre for HIV/AIDS, Dermatology and STDs , Phnom Penh , Cambodia 7. Pham Ngoc Thach Hospital , Ho Chi Minh City , Vietnam 8. Clinical Research Unit, Institut Pasteur du Cambodge , Phnom Penh , Cambodia 9. Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine , Baltimore, MD , USA 10. Research Center, Epicentre , Mbarara , Uganda 11. Department of Infectious and Tropical Diseases, University Hospital , Nîmes, France 12. Research Unit “Pathogenesis and Control of Chronical and Emerging Infections,” Inserm, French Blood Center, University of Montpellier , France 13. Service de Pneumologie, L'Institut du thorax, University Hospital, Nantes Université , France
Abstract
Abstract
Background
In people with human immunodeficiency virus (PWH), the World Health Organization–recommended tuberculosis (TB) 4-symptom screen (W4SS) targeting those who need molecular rapid testing may be suboptimal. We assessed the performance of different TB screening approaches in severely immunosuppressed PWH enrolled in the guided-treatment group of the STATIS trial (NCT02057796).
Methods
Ambulatory PWH with no overt evidence of TB and CD4 count <100 cells/µL were screened for TB prior to antiretroviral therapy (ART) initiation with W4SS, chest radiograph (CXR), urine lipoarabinomannan (LAM) test, and sputum Xpert MTB/RIF (Xpert). Correctly and wrongly identified cases by screening approaches were assessed overall and by CD4 count threshold (≤50 and 51–99 cells/µL).
Results
Of 525 enrolled participants (median CD4 count, 28 cells/µL), 48 (9.9%) were diagnosed with TB at enrollment. Among participants with a negative W4SS, 16% had either a positive Xpert, a CXR suggestive of TB, or a positive urine LAM test. The combination of sputum Xpert and urine LAM test was associated with the highest proportion of participants correctly identified as TB (95.8%) and non-TB cases (95.4%), with proportions equally high among participants with CD4 counts above or below 50 cells/µL. Restricting the use of sputum Xpert, urine LAM test, or CXR to participants with a positive W4SS reduced the proportion of wrongly and correctly identified cases.
Conclusions
There is a clear benefit to perform both sputum Xpert and urine LAM tests as TB screening in all severely immunosuppressed PWH prior to ART initiation, not only in those with a positive W4SS.
Clinical Trials Registration. NCT02057796.
Funder
Agence Nationale de Recherche sur le Sida et les hépatites virales
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Microbiology (medical)
Cited by
3 articles.
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