title: Yield of chest radiograph in tuberculosis screening for HIV-infected persons at a district-level HIV clinic.
abstract: METHODS
  An Hoa Clinic, a district-level human immunodeficiency virus (HIV) clinic in Ho Chi Minh City, Viet Nam.
  
  
  OBJECTIVE
  To assess the performance of chest radiograph (CXR) in screening for pulmonary tuberculosis (PTB) among HIV-infected individuals and identify misdiagnosed opportunities.
  
  
  METHODS
  This cross-sectional study was conducted in 397 HIV-infected patients consecutively enrolled at the An Hoa Clinic in Ho Chi Minh City, Viet Nam, from August 2009 to June 2010. The performance of CXR in TB screening was assessed based on its sensitivity, specificity, positive likelihood ratio and negative likelihood ratio.
  
  
  RESULTS
  Symptom screening alone missed 50% of PTB cases. The combination of CXR and symptom screening yielded an additional 28.6% (8/28) in PTB screening as compared with symptom screening alone, and should be applied routinely, especially in high TB prevalent settings.
  
  
  CONCLUSIONS
  CXR is a good predictor for PTB even in HIV-infected individuals. The combination of CXR and screening for common TB symptoms considerably improved the sensitivity of detecting active PTB in people living with HIV. If available, routine sputum culture and the World Health Organization-endorsed Xpert(®) MTB/RIF assay should be implemented to achieve a more accurate diagnosis.
authors.affiliation: Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA.
authors.forename: D T M
authors.initials: DT
authors.lastname: Nguyen
authors.affiliation: Pham Ngoc Thach Hospital for Tuberculosis and Lung Diseases, Ho Chi Minh City, Viet Nam.
authors.forename: N D
authors.initials: ND
authors.lastname: Bang
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam.
authors.forename: N Q
authors.initials: NQ
authors.lastname: Hung
authors.affiliation: University of Texas School of Public Health, Texas, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Beasley
authors.affiliation: University of Texas School of Public Health, Texas, USA.
authors.forename: L-Y
authors.initials: LY
authors.lastname: Hwang
authors.affiliation: Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA; University of Texas School of Public Health, Texas, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Graviss
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D060085:Coinfection; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D013902:Radiography, Thoracic; D015203:Reproducibility of Results; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult