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

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

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3 Citations (Scopus)



To identify the causes of symptoms suggestive of tuberculosis (TB) among people living with the human immunodeficiency virus (PLHIV) in South Africa.


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.


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/mm3.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 = 1each).


PLHIV with persistent TB symptoms require further evaluation for TB using all available modalities, and for food insecurity in those with weight loss.

Original languageEnglish
Pages (from-to)157-165
Number of pages9
JournalInternational Journal of Tuberculosis & Lung Disease
Issue number2
Early online date24 Jan 2019
Publication statusPublished - 1 Feb 2019
Externally publishedYes


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