Improving the diagnosis of pulmonary tuberculosis in HIV-infected individuals in Ho Chi Minh City, Viet Nam.
METHODS
District 6, An Hoa Clinic in Ho Chi Minh City (HCMC), Viet Nam.


OBJECTIVE
To evaluate the performance of various algorithms in tuberculosis (TB) screening and diagnosis in a human immunodeficiency virus (HIV) infected population in HCMC, Viet Nam.


METHODS
A cross-sectional  study of 397 consecutive HIV-infected patients seeking care at the An Hoa Clinic from August 2009 to June 2010. Data on participant demographics, clinical status, chest radiography (CXR) and laboratory results were collected. A multiple logistic regression model was developed to assess the  association of covariates and pulmonary TB (PTB).


RESULTS
The prevalence of sputum culture-confirmed PTB, acid-fast bacilli (AFB) positive TB, and multidrugresistant TB among the 397 HIV-infected patients was respectively 7%, 2%, and 0.3%. Adjusted odds ratios for low CD4+ cell count, positive  sputum smear, and CXR to positive sputum culture were respectively 3.17, 32.04 and 4.28. Clinical findings alone had poor sensitivity, but combining CD4+ cell count, AFB sputum smear and CXR had a more accurate diagnostic performance.


CONCLUSIONS
Results suggest that symptom screening had  poor clinical performance, and support the routine use of sputum culture to improve the detection of TB disease in HIV-infected individuals in Viet Nam. However, when routine sputum culture is not available, an algorithm combining CD4+ cell count, AFB sputum smear and CXR is recommended for  diagnosing PTB.
University of Texas School of Public Health, Houston, Texas 77030, USA. ntmduc@yahoo.com
D T M
DT
Nguyen
N Q
NQ
Hung
L T
LT
Giang
N H
NH
Dung
N T N
NT
Lan
N N
NN
Lan
N T B
NT
Yen
N D
ND
Bang
D V
DV
Ngoc
L T T
LT
Trinh
R P
RP
Beasley
C E
CE
Ford
L-Y
LY
Hwang
E A
EA
Graviss
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D000465:Algorithms; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D013902:Radiography, Thoracic; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology; D019037:Urban Health Services / Q000706:statistics & numerical data; D014744:Vietnam / Q000453:epidemiology