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Undiagnosed TB related to low CD4 counts in HIV
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Recent data suggest that undiagnosed tuberculosis was associated with low CD4+ T-cell counts among people with HIV — regardless of whether they receive antiretroviral therapy, according to researchers from the Aurum Institute for Health Research in Johannesburg, South Africa.
According to background information in the study, previous data have suggested that the burden of undiagnosed TB among patients treated at HIV clinics in South Africa has ranged from 19% to 35%. To reduce this burden, WHO has promoted the 3I’s strategy: intensified case finding for TB, isoniazid preventive therapy and infection control.
For the current study, researchers set out to determine factors associated with undiagnosed TB in 422 patients with HIV from an ambulatory HIV clinic between October 2009 and May 2010. This study is a secondary analysis to examine factors associated with undiagnosed TB. Patients were assessed for TB using a symptom screen, sputum-smear microscopy, sputum and blood mycobacterial culture, fine needle aspiration of enlarged lymph nodes and chest radiography.
The median age of the patients was 37 years; median CD4+ count was 215 cells/mcL. Forty-seven percent of patients had been on ART for a median of 8 months. TB symptoms were reported by 361 participants; however, 27 patients met the criteria for bacteriologically confirmed TB and 50 met the criteria for any form of TB.
Bacteriologically confirmed TB was associated with CD4+ counts of <100 cells/mcL (OR=5.05; 95% CI, 1.69-15.12). There was also an association between having a low hemoglobin level and having undiagnosed bacteriologically confirmed TB (OR=3.12; 95% CI, 1.26-7.72).
“We cannot overstate the need to strengthen implementation of administrative and environmental infection control measures,” the researchers wrote in the study. “HIV clinic attendees should be screened for a cough as they enter health facilities, and those with a cough triaged and fast tracked through the clinics to minimize time spent potentially infecting other patients and staff.”
References:
Kufa T. J Acquir Immune Defic Syndr. 2012;60:e22-e28.
Disclosures:
Two researchers received funding from the Bill & Melinda Gates Foundation, and other researchers report relationships with PricewaterhouseCoopers and Archivel Farma.