Undiagnosed tuberculosis among HIV clinic attendees: Association with antiretroviral therapy and implications for intensified case finding, isoniazid preventive therapy, and infection control

Tendesayi Kufa, Victor Mngomezulu, Salome Charalambous, Yasmeen Hanifa, Katherine Fielding, Alison D. Grant, Nikolas Wada, Richard E. Chaisson, Gavin J. Churchyard, Celine R. Gounder

Research output: Contribution to journalArticle

Abstract

Objectives: Initiation of antiretroviral therapy (ART) and the 3I's are strategies to prevent HIV-associated tuberculosis (TB). We describe factors associated with undiagnosed TB among HIV-infected patients attending an HIV clinic in South Africa and discuss implications for the 3 Is. Design: Convenience sample of HIV clinic attendees. Methods: HIV-infected participants were assessed for TB using a symptom screen, sputum-smear microscopy, sputum and blood mycobacterial culture, fine needle aspiration of enlarged lymph nodes, and chest radiography. Results: Four hundred twenty-two participants were enrolled. The median age and CD4+ T-cell count were 37 years [interquartile range (IQR): 31-44 years] and 215 cells per microliter (IQR: 107-347cells/μL). Forty-seven percent had been on ART for a median duration of 8 months (IQR: 3.3-22.8 months). Three hundred sixty-one participants (85.6%) reported TB symptoms. Twenty-seven participants (6.4%) met criteria for bacteriologically confirmed TB and 50 (11.6%) for any form of TB. Bacteriologically confirmed TB was associated with CD4+ T-cell counts ≤100 cells per microliter (odds ratio: 5.05, 95% confidence interval: 1.69 to 15.12) when compared with CD4+ T-cell counts >200 cells per microliter and hemoglobin {hemoglobin ,<10 g/dL [odds ratio 3.12 (95% confidence interval: 1.26 to 7.72)]}. Conclusions: Undiagnosed TB among HIV-infected ambulatory patients was associated with low CD4+ T-cell counts regardless of ART status. TB screening algorithms which include CD4+ T-cell count and hemoglobin testing may be an effective way to identify HIV-infected clinic attendees at highest risk of undiagnosed TB. Isoniazid preventive therapy and TB infection control are essential for reducing occurrence of HIV-associated TB even after ART initiation.

Original languageEnglish (US)
Pages (from-to)e22-e28
JournalJournal of acquired immune deficiency syndromes
Volume60
Issue number2
DOIs
StatePublished - Jun 1 2012

Keywords

  • Antiretroviral therapy
  • Case finding
  • Epidemiology
  • HIV
  • Screening
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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