%0 Journal Article
%T Performance of Clinical Algorithms for Smear-Negative Tuberculosis in HIV-Infected Persons in Ho Chi Minh City, Vietnam
%A Duc T. M. Nguyen
%A Hung Q. Nguyen
%A R. Palmer Beasley
%A Charles E. Ford
%A Lu-Yu Hwang
%A Edward A. Graviss
%J Tuberculosis Research and Treatment
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/360852
%X Background. Tuberculosis (TB) disease diagnosis in Vietnam relies on symptom screening, chest radiography (CXR), and acid fast bacilli (AFB) sputum smear which have a poor sensitivity in HIV patients. We evaluated the performance of clinical algorithms in screening and diagnosing AFB smear-negative TB in HIV patients. Methods. We enrolled 399 HIV-positive patients seeking care at a HIV clinic in Ho Chi Minh City (HCMC), Vietnam. ParticipantsĄ¯ demographics, medical history, common TB symptoms, CXR, and laboratory tests were collected. Results. Of 399 HIV patients, 390 had initial AFB-negative smears and 22/390 patients had positive cultures. Symptom screening missed 54% (12/22) of smear-negative pulmonary TB (PTB) cases. Multivariate analysis found CD4+ cell level and CXR were significant PTB predictors. An algorithm combining four TB symptoms and TST presented a high sensitivity (100%), but poorly specific (24%) diagnostic performance for smear-negative PTB. Conclusion. Up to 54% of PTB cases in the HIV-infected population may be missed in the routine screening and diagnostic procedures used in Vietnam. Symptom screening was a poor overall diagnostic measure in detecting smear-negative TB in HIV patients. Our study results suggest that routine sputum cultures should be implemented to achieve a more accurate diagnosis of TB in HIV patients. 1. Introduction HIV-infected patients with tuberculosis (TB) coinfection may present with atypical manifestations of pulmonary TB (PTB) and a higher rate of negative sputum smears for acid fast bacilli (AFB) [1¨C3]. Though being less infectious than AFB smear-positive PTB, AFB smear-negative PTB is still a potentially important source of TB transmission and predicts a worse prognosis for HIV-infected patients [4¨C6]. Therefore, early and accurate diagnosis of sputum smear-negative PTB for HIV-infected patients is urgently important for not only improving the patientĄ¯s life expectancy, but also preventing disease transmission to the general population. The diagnosis of TB disease in developing countries like Vietnam relies mainly on symptom screening, chest radiography (CXR), and AFB sputum smear, which have a poor sensitivity in HIV-positive patients [3, 7]. Sputum culture is not routinely available for smear-negative patients, especially at district-level public health institutions [7]. Moreover, current data on the performance of clinical, radiographic, and laboratory characteristics in predicting AFB smear-negative PTB for HIV-infected patients are still limited and inconsistent [6, 8]. This reasoning led us to
%U http://www.hindawi.com/journals/trt/2012/360852/