title: Performance of Xpert MTB/RIF and Alternative Specimen Collection Methods for the Diagnosis of Tuberculosis in HIV-Infected Children.
abstract: BACKGROUND
  The diagnosis of tuberculosis in human immunodeficiency virus (HIV)-infected children is challenging. We assessed the performance of alternative specimen collection methods for tuberculosis diagnosis in HIV-infected children using Xpert MTB/RIF (Xpert).
  
  
  METHODS
  HIV-infected children aged ≤13 years with suspected intrathoracic tuberculosis were enrolled in 8 hospitals in Burkina Faso, Cambodia, Cameroon, and Vietnam. Gastric aspirates were taken for children aged <10 years and expectorated sputum samples were taken for children aged ≥10 years (standard samples); nasopharyngeal aspirate and stool were taken for all children, and a string test was performed if the child was aged ≥4 years (alternative samples). All samples were tested with Xpert. The diagnostic accuracy of Xpert for culture-confirmed tuberculosis was analyzed in intention-to-diagnose and per-protocol approaches.
  
  
  RESULTS
  Of 281 children enrolled, 272 (96.8%) had ≥1 specimen tested with Xpert (intention-to-diagnose population), and 179 (63.5%) had all samples tested with Xpert (per-protocol population). Tuberculosis was culture-confirmed in 29/272 (10.7%) children. Intention-to-diagnose sensitivities of Xpert performed on all, standard, and alternative samples were 79.3% (95% confidence interval [CI], 60.3-92.0), 72.4% (95% CI, 52.8-87.3), and 75.9% (95% CI, 56.5-89.7), respectively. Specificities were ≥97.5%. Xpert combined on nasopharyngeal aspirate and stool had intention-to-diagnose and per-protocol sensitivities of 75.9% (95% CI, 56.5-89.7) and 75.0% (95% CI, 47.6-92.7), respectively.
  
  
  CONCLUSIONS
  The combination of nasopharyngeal aspirate and stool sample is a promising alternative to methods usually recommended by national programs. Xpert performed on respiratory and stools samples enables rapid confirmation of tuberculosis diagnosis in HIV-infected children.
  
  
  BACKGROUND
  The ANRS (Agence Nationale de Recherche sur le Sida) 12229 PAANTHER (Pediatric Asian African Network for Tuberculosis and HIV Research) 01 study is registered at ClinicalTrials.gov (NCT01331811).
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.|University of Bordeaux, Centre INSERM U1219, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Marcy
authors.affiliation: TB/HIV Department, National Pediatric Hospital.|University of Health Sciences, Phnom Penh, Cambodia.
authors.forename: Vibol
authors.initials: V
authors.lastname: Ung
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Sophie
authors.initials: S
authors.lastname: Goyet
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Laurence
authors.initials: L
authors.lastname: Borand
authors.affiliation: UMI 233- U1175 TransVIHMI, IRD, Université de Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Msellati
authors.affiliation: Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon.
authors.forename: Mathurin
authors.initials: M
authors.lastname: Tejiokem
authors.affiliation: Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Ngoc Lan
authors.initials: NL
authors.lastname: Nguyen Thi
authors.affiliation: Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina Faso.
authors.forename: Boubacar
authors.initials: B
authors.lastname: Nacro
authors.affiliation: Mycobacteriology Laboratory, Medical Laboratory Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Sokleaph
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Service de Mycobactériologie, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon.
authors.forename: Sara
authors.initials: S
authors.lastname: Eyangoh
authors.affiliation: Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Thu Hang
authors.initials: TH
authors.lastname: Pham
authors.affiliation: Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina Faso.
authors.forename: Abdoul-Salam
authors.initials: AS
authors.lastname: Ouedraogo
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Tarantola
authors.affiliation: Département de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Montpellier, Hôpital Arnaud de Villeneuve.|INSERM U1058, Montpellier.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Godreuil
authors.affiliation: Unité d'Immunologie Hématologie Rhumatologie Pédiatrique.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Blanche
authors.affiliation: Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Delacourt
mesh_terms: D000293:Adolescent; D012634:Bodily Secretions / Q000382:microbiology; D002050:Burkina Faso; D002160:Cambodia; D002163:Cameroon; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D004269:DNA, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009169:Mycobacterium tuberculosis / Q000235:genetics; D021141:Nucleic Acid Amplification Techniques; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis*; D014744:Vietnam
chemical_list: D004269:DNA, Bacterial
keywords: HIV infection; Xpert MTB/RIF; children; diagnosis; tuberculosis