title: Factors associated with negative direct sputum examination in Asian and African HIV-infected patients with tuberculosis (ANRS 1260).
abstract: OBJECTIVE
  To identify factors associated with negative direct sputum examination among African and Cambodian patients co-infected by Mycobacterium tuberculosis and HIV.
  
  
  METHODS
  Prospective multicenter study (ANRS1260) conducted in Cambodia, Senegal and Central African Republic.
  
  
  METHODS
  Univariate and multivariate analyses (logistic regression) were used to identify clinical and radiological features associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensen medium.
  
  
  RESULTS
  Between September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB) examination was positive in sputum samples from 110 subjects (63%) and negative in 65 patients (37%). Most patients were at an advanced stage of HIV disease (92% at stage III or IV of the WHO classification) with a median CD4 cell count of 36/mm³. In this context, we found that sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR = 2.8 [95%CI:1.1-7.0]), dyspnea (OR = 2.5 [95%CI:1.1-5.6]), and localized interstitial opacities (OR = 3.1 [95%CI:1.3-7.6]), but was less frequent with CD4 ≤ 50/mm³ (OR = 0.4 [95%CI:0.2-0.90), adenopathies (OR = 0.4 [95%CI:0.2-0.93]) and cavitation (OR = 0.1 [95%CI:0.03-0.6]).
  
  
  CONCLUSIONS
  One novel finding of this study is the association between concomitant respiratory tract infection and negative sputum AFB, particularly in Cambodia. This finding suggests that repeating AFB testing in AFB-negative patients should be conducted when broad spectrum antibiotic treatment does not lead to complete recovery from respiratory symptoms. In HIV-infected patients with a CD4 cell count below 50/mm3 without an identified cause of pneumonia, systematic AFB direct sputum examination is justified because of atypical clinical features (without cavitation) and high pulmonary mycobacterial burden.
authors: Institut Pasteur, Paris, France. chartier@pasteur.fr
authors: Loïc
authors: L
authors: Chartier
authors: Chanthy
authors: C
authors: Leng
authors: Jean-Marie
authors: JM
authors: Sire
authors: Odile
authors: O
authors: Le Minor
authors: Manil
authors: M
authors: Saman
authors: Raymond
authors: R
authors: Bercion
authors: Lila
authors: L
authors: Rahalison
authors: Arnaud
authors: A
authors: Fontanet
authors: Yves
authors: Y
authors: Germany
authors: Pierre
authors: P
authors: L'her
authors: Charles
authors: C
authors: Mayaud
authors: Muriel
authors: M
authors: Vray
mesh_terms: D000328:Adult; D001407:Bacillus / Q000302:isolation & purification; D002160:Cambodia; D002488:Central African Republic; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012675:Senegal; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000150:complications* / Q000382:microbiology*