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


CONCLUSIONS
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.
Bakari
Muhammad
M
Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. drbakari@yahoo.com
Arbeit
Robert D
RD
Mtei
Lillian
L
Lyimo
Johnson
J
Waddell
Richard
R
Matee
Mecky
M
Cole
Bernard F
BF
Tvaroha
Susan
S
Horsburgh
C Robert
CR
Soini
Hanna
H
Pallangyo
Kisali
K
von Reyn
C Fordham
CF
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001576:Benzophenoneidum; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D008400:Mass Chest X-Ray; D008828:Microbiological Techniques / Q000379:methods; D008853:Microscopy / Q000379:methods; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012235:Rhodamines; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*; D013636:Tanzania / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control
D000995:Antitubercular Agents; D012235:Rhodamines; D001576:Benzophenoneidum