high prevalence of subclinical tuberculosis in hiv-1 infected persons without advanced...

High Prevalence Of Subclinical Tuberculosis In HIV-1 Infected

Persons Without Advanced Immunodeficiency:

Implications For TB Screening Tolu ONI

Imperial College London

University of Cape Town

20 June 2011

Abstract no. WEPDB0206

INTRODUCTION

AIM

To describe the prevalence and outcome of subclinical TB disease in HIV-1-infected persons not eligible for ART.

METHODS

Setting: Khayelitsha

Participants:

- 274 asymptomatic persons from pre-ART wellness clinic or at HCT (+162 symptomatic TB cases for comparison)

TB screening, Tuberculin skin test (TST), CXR if TST >4mm

Spoligotyping

KEY FINDINGS

8.5% (95% C.I. 5.1-13.0%) prevalence of asymptomatic TB disease, with good clinical outcomes

Spoligotyping effectively excludes cross-contamination

71% of those with TST ≥ 5mm had normal CXR

Findings suggest lower bacterial burden compared to symptomatic TB cases

56% progressed clinically, median 28 days later

Suggests increasing bacterial load and actively replicating bacilli

Treatment received earlier with potential public health significance (22% smear positive)

POLICY IMPLICATIONS

Results suggest that in high HIV/TB transmission settings, HIV-1 infection should prompt a TB test by sputum culture especially in persons with

-TST ≥5mm (OR 4.96; p=0.064)

- lower CD4 counts (OR 0.996; p=0.06)

- longer history of HIV (OR 1.006; p=0.056)

Highlights need for new rapid and affordable point-of-care diagnostic tests to identify persons with clinical and subclinical TB disease.

ACKNOWLEDGMENTS Lebo Tsekela

Hannah Gideon

Nonzwakazi Bangani

Ronnett Seldon

Rachael Burke

Kathryn Wood

Katalin Wilkinson

Tom Ottenhoff

Robert Wilkinson

Study Participants