title: Diagnostic value of an immunochromatographic test over clinical predictors for tuberculosis in HIV patients.
abstract: OBJECTIVE
  The value of an immunochromatographic test for tuberculosis (ICT-TB) combined with clinical predictors has yet to be evaluated in Thailand. This study aimed to assess any additional diagnostic value of an ICT-TB test over that of clinical predictors in a group of human immunodeficiency virus (HIV) patients as well as in subgroups of HIV patients classified by clinical risk scores.
  
  
  METHODS
  An extended cross-sectional study was conducted at a community hospital in Chiang Rai and a general hospital in Lampang. HIV patients registered between April 2009 and May 2010 were screened by a locally made ICT-TB test, including 38, 16, and 6 kD Microbacterium tuberculosis antigens, as well as by routine evaluations for TB diagnosis. Demographic data, medical history, signs, and symptoms were recorded. Participants were followed up for 2 months for final ascertainment of TB diagnosis.
  
  
  RESULTS
  Of 206 patients, 37 (18%) had TB. Four clinical predictors were identified: low body mass index (<19 kg/m(2)), prolonged cough (duration >2 weeks), shaking chills (≥1 week), and no use of antiretrovirals. The area under the receiver operating curve was 90.2%; adding the ICT-TB test result increased the area nonsignificantly to 91.6% (P = 0.40). When patients were categorized by risk scores derived from selected clinical predictors into low (scores ≤7) and high (scores >7) TB risk groups, a positive ICT-TB test increased the positive predictive value nonsignificantly in the low risk group (from 12.5% to 27.3%, P = 0.17) and the high risk group (from 78.6% to 80.8%, P = 0.73).
  
  
  CONCLUSIONS
  In this study setting, the ICT-TB test did not enhance TB diagnosis over the four clinical predictors in the overall group or any subgroups of HIV patients classified by clinical risk scores.
authors: Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand;
authors: Sirisak
authors: S
authors: Nanta
authors: Patcharee
authors: P
authors: Kantipong
authors: Panita
authors: P
authors: Pathipvanich
authors: Chidchanok
authors: C
authors: Ruengorn
authors: Chamaiporn
authors: C
authors: Tawichasri
authors: Jayanton
authors: J
authors: Patumanond