title: Prevalence of national treatment algorithm defined smear positive pulmonary tuberculosis in HIV positive patients in Brazzaville, Republic of Congo.
abstract: BACKGROUND
  In the Republic in Congo, the national algorithm for the diagnosis of pulmonary tuberculosis (TB) relies on Ziehl-Neelsen (ZN) sputum smear microscopy, chest X-ray radiography (CXR) and clinical symptoms. Microscopy positive pulmonary TB (MPT+) is defined as symptoms of TB and a positive ZN smear. Microscopy negative pulmonary TB (MPT-) is defined as symptoms of TB, a negative ZN smear but CXR changes consistent with TB. The present cross-sectional study was designed to determine the prevalence of positive and negative MPT individuals among HIV positive and HIV negative individuals presenting to an ambulatory TB treatment center (CTA) in Brazzaville.
  
  
  METHODS
  All study participants underwent a physical examination, chest radiography and three ZN sputum smear examinations and HIV testing. Viral load and CD4 counts were determined for HIV positive individuals.
  
  
  RESULTS
  775 individuals presented with symptoms of TB. 425 individuals accepted the voluntary HIV test. 133 (31.3%) were HIV positive (HIV+) and 292 (68.7%) were HIV negative (HIV-). Of the 292 HIV- individuals 167 (57%) were classified as positive MPT and 125 (43%) as negative MPT. Of the 133 HIV positive individuals 39 (29%) were classified as MPT + and 94 (71%) as MPT-.
  
  
  CONCLUSIONS
  Our study shows that the prevalence of positive MPT individuals is lower among HIV positive individuals compared to HIV negative individuals in agreement to reports from other countries. The data suggest that a substantial number of HIV positive pulmonary TB cases are not detected by the national algorithm and highlight the need for new diagnostic tests in this population.
authors.forename: Laure Stella Ghoma
authors.initials: LS
authors.lastname: Linguissi
authors.forename: Pembe Issamou
authors.initials: PI
authors.lastname: Mayengue
authors.forename: Anissa
authors.initials: A
authors.lastname: Sidibé
authors.forename: Jeannhey C
authors.initials: JC
authors.lastname: Vouvoungui
authors.forename: Mitawa
authors.initials: M
authors.lastname: Missontsa
authors.forename: Igor Kevin
authors.initials: IK
authors.lastname: Madzou-Laboum
authors.forename: Gaston Bango
authors.initials: GB
authors.lastname: Essassa
authors.forename: Sunny
authors.initials: S
authors.lastname: Oyakhirome
authors.forename: Matthias
authors.initials: M
authors.lastname: Frank
authors.forename: Veronique
authors.initials: V
authors.lastname: Penlap
authors.affiliation: Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of Congo. fntoumi@fcrm-congo.com.
authors.forename: Francine
authors.initials: F
authors.lastname: Ntoumi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000328:Adult; D000465:Algorithms; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis*; D019562:Viral Load