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