Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.
Haileyesus Getahun,Wanitchaya Kittikraisak,Charles M. Heilig,Elizabeth L. Corbett,Helen Ayles,Helen Ayles,Kevin P. Cain,Alison D. Grant,Gavin J. Churchyard,Michael E. Kimerling,Sarita Shah,Stephen D. Lawn,Stephen D. Lawn,Robin Wood,Gary Maartens,Reuben Granich,Anand Date,Jay K. Varma +17 more
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TLDR
A simple, standardized tuberculosis screening rule for resource-constrained settings is reported, to identify people living with HIV who need further investigation for TB disease.Abstract:
Background: The World Health Organization recommends the screening of all people living with HIV for tuberculosis (TB) disease, followed by TB treatment, or isoniazid preventive therapy (IPT) when TB is excluded. However, the difficulty of reliably excluding TB disease has severely limited TB screening and IPT uptake in resource-limited settings. We conducted an individual participant data meta-analysis of primary studies, aiming to identify a sensitive TB screening rule. Methods and Findings: We identified 12 studies that had systematically collected sputum specimens regardless of signs or symptoms, at least one mycobacterial culture, clinical symptoms, and HIV and TB disease status. Bivariate random-effects meta-analysis and the hierarchical summary relative operating characteristic curves were used to evaluate the screening performance of all combinations of variables of interest. TB disease was diagnosed in 557 (5.8%) of 9,626 people living with HIV. The primary analysis included 8,148 people living with HIV who could be evaluated on five symptoms from nine of the 12 studies. The median age was 34 years. The best performing rule was the presence of any one of: current cough (any duration), fever, night sweats, or weight loss. The overall sensitivity of this rule was 78.9% (95% confidence interval [CI] 58.3%–90.9%) and specificity was 49.6% (95% CI 29.2%–70.1%). Its sensitivity increased to 90.1% (95% CI 76.3%–96.2%) among participants selected from clinical settings and to 88.0% (95% CI 76.1%–94.4%) among those who were not previously screened for TB. Negative predictive value was 97.7% (95% CI 97.4%–98.0%) and 90.0% (95% CI 88.6%–91.3%) at 5% and 20% prevalence of TB among people living with HIV, respectively. Abnormal chest radiographic findings increased the sensitivity of the rule by 11.7% (90.6% versus 78.9%) with a reduction of specificity by 10.7% (49.6% versus 38.9%). Conclusions: Absence of all of current cough, fever, night sweats, and weight loss can identify a subset of people living with HIV who have a very low probability of having TB disease. A simplified screening rule using any one of these symptoms can be used in resource-constrained settings to identify people living with HIV in need of further diagnostic assessment for TB. Use of this algorithm should result in earlier TB diagnosis and treatment, and should allow for substantial scale-up of IPT. Please see later in the article for the Editors’ Summary.read more
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A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa.
Christine Danel,Raoul Moh,Delphine Gabillard,Anani Badje,Le Carrou J,Ouassa T,Eric Ouattara,Anzian A,Jean-Baptiste Ntakpe,Albert Minga,Gérard-Menan Kouamé,Bouhoussou F,Emieme A,Abo Kouame,Inwoley A,Toni Td,Ahiboh H,Kabran M,Rabe C,Sidibé B,Nzunetu G,Konan R,Gnokoro J,Gouesse P,Messou E,Dohoun L,Kamagate S,Yao A,Amon S,Kouame Ab,Koua A,Kouamé E,Ndri Y,Ba-Gomis O,Daligou M,Ackoundzé S,Hawerlander D,Ani A,Dembélé F,Koné F,Guéhi C,Kanga C,Koule S,Séri J,Oyebi M,Mbakop N,Makaila O,Babatunde C,Babatounde N,Bleoué G,Tchoutedjem M,Kouadio Ac,Sena G,Yededji Sy,Assi R,Bakayoko A,Mahassadi A,Attia A,Oussou A,Mobio M,Bamba D,Koman M,Horo A,Nina Deschamps,Chenal H,Sassan-Morokro M,Konate S,Aka K,Aoussi E,Journot,Nchot C,Sophie Karcher,Chaix Ml,Christine Rouzioux,Sow Ps,Perronne C,Girard Pm,Menan H,Bissagnene E,Kadio A,Ettiegne-Traore,Moh-Semdé C,Massumbuko Jm,Chêne G,Dosso M,Domoua Sk,N'Dri-Yoman T,Roger Salamon,Serge-Paul Eholié,Xavier Anglaret +89 more
TL;DR: In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter.
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Latent Mycobacterium tuberculosis Infection
TL;DR: The pathogenesis, epidemiology, diagnosis, and treatment of latent tuberculosis infection is reviewed to address critical gaps in the understanding of this complex condition and propose the necessary research agenda.
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Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries.
Haileyesus Getahun,Alberto Matteelli,Ibrahim Abubakar,Mohamed Abdel Aziz,Annabel Baddeley,Draurio Barreira,Saskia Den Boon,Susana Marta Borroto Gutierrez,Judith Bruchfeld,Erlina Burhan,Solange Cavalcante,Rolando Cedillos,Richard E. Chaisson,Cynthia B.E. Chee,Lucy Chesire,Elizabeth L. Corbett,Masoud Dara,Justin T Denholm,Gerard De Vries,Dennis Falzon,Nathan Ford,Margaret Gale-Rowe,Chris Gilpin,Enrico Girardi,Un Yeong Go,Darshini Govindasamy,Alison D. Grant,Malgorzata Grzemska,Ross J Harris,C. Robert Horsburgh,Asker Ismayilov,Ernesto Jaramillo,Sandra V. Kik,Katharina Kranzer,Christian Lienhardt,Philip A. LoBue,Knut Lönnroth,Guy B. Marks,Dick Menzies,Giovanni Battista Migliori,Davide Mosca,Ya Diul Mukadi,Alwyn Mwinga,Lisa J. Nelson,Nobuyuki Nishikiori,Anouk M. Oordt-Speets,Molebogeng Xheedha Rangaka,Andreas Reis,Lisa D. Rotz,Andreas Sandgren,Monica Sañé Schepisi,Holger J. Schünemann,Surender Kumar Sharma,Giovanni Sotgiu,Helen R. Stagg,Timothy R. Sterling,Tamara Tayeb,Mukund Uplekar,Marieke J. van der Werf,Wim Vandevelde,Femke van Kessel,Anna H. van’t Hoog,Jay K. Varma,Natalia Vezhnina,Constantia Voniatis,Marije Vonk Noordegraaf-Schouten,Diana Weil,Karin Weyer,Robert J. Wilkinson,Takashi Yoshiyama,Jean-Pierre Zellweger,Mario C. Raviglione +71 more
TL;DR: The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation and patients with silicosis.
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Antiretroviral Therapy for Prevention of Tuberculosis in Adults with HIV: A Systematic Review and Meta-Analysis
Amitabh B. Suthar,Stephen D. Lawn,Stephen D. Lawn,Julia del Amo,Haileyesus Getahun,Christopher Dye,Delphine Sculier,Timothy R. Sterling,Richard E. Chaisson,Brian G. Williams,Anthony D. Harries,Anthony D. Harries,Reuben Granich +12 more
TL;DR: In a systematic review and meta-analysis, Amitabh Suthar and colleagues investigate the association between antiretroviral therapy and the reduction in the incidence of tuberculosis in adults with HIV infection.
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Scaling up interventions to achieve global tuberculosis control: progress and new developments
Mario C. Raviglione,Ben J. Marais,Katherine Floyd,Knut Lönnroth,Haileyesus Getahun,Giovanni Battista Migliori,Anthony D. Harries,Anthony D. Harries,Paul Nunn,Christian Lienhardt,Steve Graham,Steve Graham,Jeremiah Chakaya,Karin Weyer,Stewart T. Cole,Stefan H. E. Kaufmann,Alimuddin Zumla +16 more
TL;DR: With improved control efforts, the world and most regions are on track to achieve the Millennium Development Goal of decreasing tuberculosis incidence by 2015, and the Stop TB Partnership target of halving 1990 mortality rates by 2015; the exception is Africa.
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