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Free Content Detection of human immunodeficiency virus infection in the sputum of tuberculosis patients in South India

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SETTING: A DOTS clinic in an academic tertiary referral hospital in South India.

OBJECTIVE: To evaluate the performance of two rapid enzyme-linked immunoassays (EIAs) for the detection of human immunodeficiency virus (HIV) infection in sputum samples of patients with tuberculosis (TB).

DESIGN: We prospectively recruited 522 consecutive out-patients presenting to the DOTS clinic with confirmed TB of any type to undergo HIV testing using reference serum EIA and index-blinded parallel sputum HIV testing with two rapid EIAs designed for oral mucosal transudate.

RESULTS: HIV positivity was 14.9% (95%CI 12.1–18.4). Compared to reference serum EIA, the Oraquick™ assay was 93.1% sensitive (95%CI 83.8–97.4) and 95.3% specific (95%CI 92.7–96.9), while the Aware™ assay was 92.3% sensitive (95%CI 83.4–96.8) and 96.6% specific (95%CI 94.4–98.0). The positive predictive values were respectively 77.0% and 82.7%. After freezing of sputum, the sensitivity of both assays declined, but the specificity significantly increased. Higher sputum volume reduced the odds of obtaining a true result with both assays.

CONCLUSION: HIV testing of fresh sputum is not sufficiently accurate for anonymous HIV surveillance among TB patients in a setting of low (<10%) HIV prevalence. Freezing sputum samples and limiting sputum volume for HIV testing may improve assay specificity.
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Keywords: HIV; India; enzyme immunoassay; sputum; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA 2: Department of Medicine, Christian Medical College, Vellore, India

Publication date: 2010-10-01

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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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