Abstract:
BACKGROUND: Active tuberculosis (TB) is common among HIV-infected persons living
in tuberculosis endemic countries, and screening for tuberculosis (TB) is
recommended routinely. We sought to determine the role of chest x-ray and sputum
culture in the decision to treat for presumptive TB using active case finding in
a large cohort of HIV-infected patients.
METHODS: Ambulatory HIV-positive subjects with CD4 counts > or = 200/mm3 entering
a Phase III TB vaccine study in Tanzania were screened for TB with a physical
examination, standard interview, CD4 count, chest x-ray (CXR), blood culture for
TB, and three sputum samples for acid fast bacillus (AFB) smear and culture.
RESULTS: Among 1176 subjects 136 (12%) were treated for presumptive TB. These
patients were more frequently male than those without treatment (34% vs. 25%,
respectively; p = 0.049) and had lower median CD4 counts (319/microL vs.
425/microL, respectively; p < .0001). Among the 136 patients treated for TB, 38
(28%) had microbiologic confirmation, including 13 (10%) who had a normal CXR and
no symptoms. There were 58 (43%) treated patients in whom the only positive
finding was an abnormal CXR. Blood cultures were negative in all patients.
CONCLUSION: Many ambulatory HIV-infected patients with CD4 counts > or = 200/mm3
are treated for presumptive TB. Our data suggest that optimal detection requires
comprehensive evaluation, including CXR and sputum culture on both symptomatic
and asymptomatic subjects.
