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Free Content Diagnosing smear-negative tuberculosis using case definitions and treatment response in HIV-infected adults

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OBJECTIVE: To assess the diagnostic utility of expanded case definitions for HIV-associated smear-negative pulmonary tuberculosis (PTB) and extra-pulmonary TB (EPTB), and to derive objective criteria for response to anti-tuberculosis treatment.

DESIGN: A prospective cohort study of HIV-infected adults who met expanded clinical case definitions for smear-negative PTB and EPTB.

METHODS: All participants were started on rifampicin-based anti-tuberculosis treatment after mycobacterial cultures from multiple sites. At weeks 2, 4 and 8, response to treatment (RTT) was assessed by measuring changes in weight, haemoglobin, C-reactive protein, Karnofsky performance score and symptom count ratio.

RESULTS: Of 147 participants enrolled, 105 (71%) were diagnosed with definite (culture-positive) or probable (histological features) TB and 25 (17%) with possible TB (treatment response). The positive predictive value for the most common case definitions ranged from 89% to 96%. Significant improvements in all the RTT parameters occurred in the subjects with confirmed TB (P < 0.001). Clinically relevant RTT criteria were derived, two or more of which were met at week 8 in 97.5% of subjects with confirmed TB, 91.3% of subjects with possible TB and none of the subjects without TB.

CONCLUSION: Expanded case definitions could enhance the diagnosis of PTB and EPTB in HIV-infected adults in resource-limited settings. Using objective criteria, RTT can be assessed within 8 weeks of initiating anti-tuberculosis treatment.
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Keywords: Africa; HIV/AIDS; case definitions; smear-negative tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Medicine, Division of Infectious Diseases, University of Cape Town, Cape Town, South Africa 2: Department of International Health, Bloomberg School of Public Health, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA 3: Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA 4: Division of Pharmacology, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Publication date: January 1, 2006

More about this publication?
  • 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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