Tuberculosis in asymptomatic HIV-infected adults with abnormal chest radiographs screened for tuberculosis prevention.
BACKGROUND
Isoniazid preventive therapy (IPT) prevents tuberculosis (TB) in people living with HIV (human immunodeficiency virus, PLWH). Symptom screening without chest radiographs (CXRs) was established as the strategy for excluding TB disease among PLWH seeking IPT in Botswana's 2001 pilot project. This strategy was evaluated in 2004-2006 among candidates screened for an IPT clinical trial.


METHODS
PLWH referred from clinics and HIV testing centers were screened for TB symptoms. All asymptomatic candidates received CXRs; those with abnormal CXRs were investigated further.


RESULTS
Among 2732 asymptomatic candidates screened, 302 (11%) had abnormal CXRs potentially compatible with TB; TB disease was diagnosed in 43 of these 302 (14%), or 43 (1.6%) of the 2732 asymptomatic candidates. While not associated with CD4 lymphocyte counts < 200 cells/mm(3), TB was associated with a positive tuberculin skin test (relative risk 2.1, 95%CI 1.1-4.0). IPT was initiated in 113 (62%) of 182 asymptomatic PLWH with abnormal CXRs; 8/113 (7%) subsequently developed TB, and 7/8 (88%) successfully completed anti-tuberculosis treatment.


CONCLUSIONS
The prevalences of abnormal CXRs and TB were respectively 2.6- and 8.9-fold higher among asymptomatic PLWH screened for the trial than in the pilot. A cost-effectiveness analysis is needed to determine whether the benefits of symptom screening alone are offset by the risk of inducing INH resistance by excluding CXRs during screening.
Agizew
T B
TB
BOTUSA, Gaborone, Botswana.
Arwady
M A
MA
Yoon
J C
JC
Nyirenda
S
S
Mosimaneotsile
B
B
Tedla
Z
Z
Motsamai
O
O
Kilmarx
P H
PH
Wells
C D
CD
Samandari
T
T
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001902:Botswana / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002986:Clinical Trials as Topic; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008400:Mass Chest X-Ray / Q000379:methods; D008403:Mass Screening / Q000379:methods*; D010865:Pilot Projects; D015995:Prevalence; D016896:Treatment Outcome; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control
D000995:Antitubercular Agents; D007538:Isoniazid