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Active case-finding shows HIV/TB coinfection prevalent in country of Georgia
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An active case-finding strategy uncovered a “very high prevalence” of tuberculosis coinfection among newly diagnosed HIV-infected patients in the country of Georgia, according to a recent study.
The findings resulted in the implementation of a nationwide TB testing strategy, researchers reported.
“Given the magnitude of the drug-resistant TB burden in the country of Georgia and low HIV coinfection rates — 1% to 4% — among patients with TB, HIV/TB coinfection often gets overlooked and receives limited attention,” Russell Kempker, MD, MSc, associate professor of medicine in the division of infectious diseases at Emory University School of Medicine, told Infectious Disease News.
“We thus carried out this study to evaluate if active pulmonary TB disease was common among newly diagnosed HIV-infected patients in the country of Georgia, and to help determine if active TB case finding should be employed among newly diagnosed HIV patients.”
Kempker and colleagues assessed newly diagnosed patients with HIV for symptoms and asked them to submit sputum samples for smear microscopy, culture and molecular diagnostic testing using the Xpert MTB/RIF assay (Cepheid).
According to the study, of the 131 patients with HIV who agreed to participate in the study, 103 submitted sputum samples. Testing showed that 46% of patients were positive for hepatitis C virus antibodies and their median CD4 count was 122 cells/mm3.
A total of 15 participants — representing 11.5% of enrolled participants, and 14.6% of those with sputum samples — were diagnosed with pulmonary TB, including one with multidrug-resistant TB and one with isoniazid-resistant disease, Kempker and colleagues reported. Twelve participants had a positive culture for Mycobacterium tuberculosis, 12 had a positive result via the Xpert TB/RIF assay, and four had positive smear microscopy, the researchers reported.
According to Kempker, based on the results, the Infectious Diseases, AIDS and Clinical Immunology Research Center in Georgia implemented an active TB case-finding strategy among all newly diagnosed HIV-infected patients consisting of a WHO-recommended symptom screen and, for patients with a positive symptom screen, a sputum Xpert MTB/RIF test.
With the new screening process, patients with a positive molecular test are referred to the National Center for Tuberculosis and Lung Diseases for further management. Kempker said the active case-finding strategy is essential not only to diagnose and treat HIV/TB coinfected patients early in their disease course but also to help stop the transmission of TB in the community.
“Active TB case finding was found to be high yield among newly diagnosed HIV-infected patients and should be considered in all settings endemic for TB. Symptom screening, followed by sputum molecular testing, offers a feasible approach to rapidly screen and test HIV patients for TB,” Kempker said. “Our results also highlight that beyond high rates of drug-resistant TB, rates of TB are extremely high — and similar to many countries in Sub Saharan Africa — among HIV-infected patients in the country of Georgia.” – by Caitlyn Stulpin
Disclosure: Kempker reports no relevant financial disclosures.
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