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Free Content Association of chest radiographic abnormalities with tuberculosis disease in asymptomatic HIV-infected adults

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SETTING: Francistown and Gaborone, Botswana.

OBJECTIVE: Chest radiography is used to screen for tuberculosis (TB) in asymptomatic persons living with the human immunodeficiency virus (PLWH) seeking isoniazid preventive therapy (IPT). We describe radiographic features in PLWH in a TB-endemic setting and identify features associated with TB disease.

DESIGN: Asymptomatic PLWH seeking IPT under program conditions for a clinical trial between 2004 and 2006 received chest radiographs (CXRs) that were read using the standardized Chest Radiograph Reading and Recording System (CRRS). Clinical characteristics, including TB disease, were compared with the radiographic findings.

RESULTS: From 2732 screening CXRs, 183 had one or more abnormalities and were scored using CRRS, with 42% having infiltrates (36% upper lobes), 35% parenchymal fibrosis and 32% adenopathy. TB disease status was determined in 129 (70%) PLWH, of whom 22 (17%) had TB disease. TB disease was associated with upper lobe infiltrates (relative risk [RR] 3.0, 95%CI 1.5–6.2) and mediastinal adenopathy (RR 3.9, 95%CI 1.8–8.4). The sensitivity and specificity of either upper lobe infiltrates or mediastinal lymphadenopathy for TB disease were respectively 64% and 82%.

CONCLUSION: A combination of CXR features was useful for predicting TB disease in asymptomatic PLWH. CRRS should be used more frequently in similar studies.

Keywords: HIV; chest radiograph; screening; tuberculosis

Document Type: Regular Paper

Affiliations: 1: BOTUSA, Gaborone, Botswana 2: Nyangabgwe Referral Hospital, Francistown, Botswana 3: School of Medicine, West Virginia University, Morgantown, West Virginia, USA 4: Disease Control Unit, Ministry of Health, Gaborone, Botswana 5: BOTUSA, Gaborone, Botswana; and Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Publication date: 2010-03-01

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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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