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Free Content Tuberculin skin test results in HIV-infected patients in India: implications for latent tuberculosis treatment

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OBJECTIVE: To evaluate the utility of the tuberculin skin test (TST) in detecting latent and active tuberculosis (TB) among human immunodeficiency virus (HIV) infected patients in South India.

DESIGN: TSTs and CD4 counts were collected from 631 HIV-infected individuals without active TB and 209 antiretroviral and anti-tuberculosis treatment-naïve HIV-infected patients with TB. We calculated the proportion of TST-positive individuals, as well as the sensitivity, specificity, positive predictive value (PPV) and negative predictive value of TST in the diagnosis of TB.

RESULTS: Among subjects without active TB, 28% with a CD4 count <100 cells/l vs. 43% of the total cohort had a TST >5 mm (P = 0.14), while the proportions with induration >10 mm were 14% vs. 36%, respectively (P < 0.01). Among those with active TB, using a 5 mm cut-off, the sensitivity was 42% for those with CD4 counts <200 cells/l compared to 70% for those with CD4 counts ≥200 cells/l (P < 0.001). The PPV for detecting active TB was 29%.

CONCLUSIONS: TST is a poor predictor of both latent and active TB in HIV-infected individuals in TB endemic countries. Programmes offering treatment for latent TB should consider including all HIV-positive patients regardless of TST status, or use other indicators, such as CD4 count.

Keywords: HIV; India; anergy; latent tuberculosis infection; tuberculin skin test

Document Type: Regular Paper

Affiliations: 1: Tuberculosis Research Centre, Chennai, India 2: Department of Medicine, University of California at San Francisco, San Francisco, California, USA 3: Division of Infectious Diseases, Miriam Hospital, Brown University, Providence, Rhode Island, USA

Publication date: February 1, 2008

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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