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Open Access What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations?

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OBJECTIVE: To identify the causes of symptoms suggestive of tuberculosis (TB) among people living with the human immunodeficiency virus (PLHIV) in South Africa.

METHODS: A consecutive sample of HIV clinic attendees with symptoms suggestive of TB (1 of cough, weight loss, fever or night sweats) at enrolment and at 3 months, and negative initial TB investigations, were systematically evaluated with standard protocols and diagnoses assigned using standard criteria. TB was ‘confirmed' if Mycobacterium tuberculosis was identified within 6 months of enrolment, and ‘clinical' if treatment started without microbiological confirmation.

RESULTS: Among 103 participants, 50/103 were pre-antiretroviral therapy (ART) and 53/103 were on ART; respectively 68% vs. 79% were female; the median age was 35 vs. 45 years; the median CD4 count was 311 vs. 508 cells/mm3. Seventy-two (70%) had 5% measured weight loss and 50 (49%) had cough. The most common final diagnoses were weight loss due to severe food insecurity (n = 20, 19%), TB (n = 14, 14%: confirmed n = 7; clinical n = 7), other respiratory tract infection (n = 14, 14%) and post-TB lung disease (n = 9, 9%). The basis for TB diagnosis was imaging (n = 7), bacteriological confirmation from sputum (n = 4), histology, lumbar puncture and other (n = 1 each).

CONCLUSION: PLHIV with persistent TB symptoms require further evaluation for TB using all available modalities, and for food insecurity in those with weight loss.
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Keywords: South Africa; TB symptoms; Xpert® MTB/RIF; human immunodeficiency virus

Document Type: Research Article

Affiliations: 1: TB Centre, London School of Hygiene & Tropical Medicine, London, UK 2: Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, University of the Witwatersrand, Johannesburg 3: The Aurum Institute, Johannesburg, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 4: TB Centre, London School of Hygiene & Tropical Medicine, London, UK, The Aurum Institute, Johannesburg, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Advancing Care and Treatment for TB-HIV, South African Medical Research Council Collaborating Centre for HIV and TB, Tygerberg 5: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 6: The Aurum Institute, Johannesburg 7: Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, National Health Laboratory Service, Johannesburg 8: National Health Laboratory Service, Johannesburg, Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 9: TB Centre, London School of Hygiene & Tropical Medicine, London, UK, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa

Publication date: February 1, 2019

This article was made available online on January 24, 2019 as a Fast Track article with title: "What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations?".

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 lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

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

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