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

Hanifa, Y., Toro Silva, S., Karstaedt, A., Sahid, F., Charalambous, S., Chihota, V. N., Churchyard, G. J., von Gottberg, A., McCarthy, K., Nicol, M. P., Ndlovu, N. T., Stevens, W., Fielding, K. L. and Grant, A. D.

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/mm(3). 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.

April 12, 2019
Year of publication
Resource types
Journal and research articles
HIV-associated tuberculosis, food insecurity, people living with HIV (PLHIV)

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