title: Diagnostic accuracy and clinical role of rapid C-reactive protein testing in HIV-infected individuals with presumed tuberculosis in South Africa.
abstract: OBJECTIVE
  To determine the accuracy and role of rapid C-reactive protein (CRP) testing in human immunodeficiency virus (HIV) infected individuals with presumed tuberculosis (TB).
  
  
  METHODS
  We enrolled HIV-infected adults (≥18 years)with a cough of ≥2 weeks and negative sputum smears for acid-fast bacilli in KwaZulu-Natal, South Africa. Participants were evaluated for pulmonary TB (PTB) by a nurse with rapid CRP, and independently by a physician by chest radiograph. Rapid CRP test results were compared with laboratory CRP and sputum sent for confirmation of TB.
  
  
  RESULTS
  Among 93 participants, 55 (59%) were female, the mean age was 35 years, and the median CD4 count was 177/mm3. Forty-five (54%) participants were diagnosed with PTB. Diagnostic sensitivity and specificity were respectively 95% (95%CI 74–99) and 51%(95%CI 35–66) for rapid CRP >8 mg/l, 87% (95%CI 73–96) and 53% (95%CI 38–68) for nurse assessment, and 69% (95%CI 52–83) and 76% (95%CI 61–87) for physician examination. Combining a negative rapid CRP(≤8 mg/l) with nurse and physician assessments reduced the post-test probability of PTB from 22% to 6% and from 32% to 6%, respectively.
  
  
  CONCLUSIONS
  Rapid CRP testing helped exclude PTB,and may be a valuable test in assisting nurses and physicians in TB-endemic regions.
authors: P K
authors: PK
authors: Drain
authors: L
authors: L
authors: Mayeza
authors: P
authors: P
authors: Bartman
authors: R
authors: R
authors: Hurtado
authors: P
authors: P
authors: Moodley
authors: S
authors: S
authors: Varghese
authors: G
authors: G
authors: Maartens
authors: G G
authors: GG
authors: Alvarez
authors: D
authors: D
authors: Wilson
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D019353:Endemic Diseases; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein