title: Improving diagnosis of pulmonary tuberculosis among HIV/AIDS patients: literature review and experience in a teaching hospital in Indonesia.
abstract: HIV infection hampers diagnosis of pulmonary tuberculosis (PTB) because many pathogens cause pulmonary infection in HIV people and the load of Mycobacterium tuberculosis is lower in HIV patients. We conducted a literature review and prospectively examined clinical, radiological, and laboratory diagnosis of PTB in 71 HIV-patients (29 inpatients and 42 outpatients) in a teaching hospital in West Java, Indonesia. For both in- and outpatients, signs and symptoms were sensitive but not specific for PTB. Chest X-ray (CXR) was sensitive but less specific. Among hospitalized PTB suspects, 28,8% could not expectorate sputum. Compared to culture, ZN had a sensitivity of 11.1% and 66.7% for in- and outpatients, respectively. From the literature, fluorescence microscopy, liquid culture, and nucleic acid assays can improve diagnosis of PTB in HIV, while IFNg-release assays lack sensitivity, especially in advanced HIV. The current practice of using CXR and microscopy lacks sensitivity for diagnosing PTB in HIV patients. Sputum culture is more sensitive but slow. Fluorescence microscopy might be a quick, relatively sensitive and feasible option in Indonesia. However, because of the frequent absence of sputum, especially in patients with advanced HIV-AIDS patients, there is an urgent need for alternative diagnostic methods using blood or urine.
authors.affiliation: On Behalf of IMPACT (Integrated Management for Prevention and Control and Treatment of HIV/ AIDS) Project, Bandung, Indonesia, Health Research Unit, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital. Jl. Pasirkaliki no. 190, Bandung 40151, Indonesia. lidyarewata@yahoo.com
authors.forename: Lidya
authors.initials: L
authors.lastname: Rewata
authors.forename: Merrin
authors.initials: M
authors.lastname: Rutherford
authors.forename: Lika
authors.initials: L
authors.lastname: Apriani
authors.forename: Willem
authors.initials: W
authors.lastname: Janssen
authors.forename: Andri
authors.initials: A
authors.lastname: Rahmadi
authors.forename: Ida
authors.initials: I
authors.lastname: Parwati
authors.forename: Arto
authors.initials: A
authors.lastname: Yuwono
authors.forename: Reinout
authors.initials: R
authors.lastname: van Crevel
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000328:Adult; D005260:Female; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*