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

Research output: Contribution to journalArticle

Abstract

OBJECTIVE

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

METHODS

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.

RESULTS

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).

CONCLUSION

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
Volume23
Issue number2
Early online date24 Jan 2019
DOIs
Publication statusPublished - 1 Feb 2019
Externally publishedYes

Fingerprint

Tuberculosis
HIV
Weight Loss
Food Supply
Cough
Spinal Puncture
Sweat
CD4 Lymphocyte Count
South Africa
Sputum
Mycobacterium tuberculosis
Respiratory Tract Infections
Lung Diseases
Histology
Fever
Therapeutics

Cite this

Hanifa, Y., Toro Silva, S., Karstaedt, A., Sahid, F., Charalambous, S., Chihota, V. N., ... Grant, A. D. (2019). What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations? International Journal of Tuberculosis & Lung Disease, 23(2), 157-165. https://doi.org/10.5588/ijtld.18.0251
Hanifa, Y ; Toro Silva, S ; Karstaedt, A ; Sahid, F ; Charalambous, S ; Chihota, V N ; Churchyard, G J ; von Gottberg, A ; McCarthy, K ; Nicol, M P ; Ndlovu, N T ; Stevens, W ; Fielding, K L ; Grant, A D. / What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations?. In: International Journal of Tuberculosis & Lung Disease. 2019 ; Vol. 23, No. 2. pp. 157-165.
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title = "What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations?",
abstract = "OBJECTIVETo identify the causes of symptoms suggestive of tuberculosis (TB) among people living with the human immunodeficiency virus (PLHIV) in South Africa.METHODSA 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.RESULTSAmong 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).CONCLUSIONPLHIV with persistent TB symptoms require further evaluation for TB using all available modalities, and for food insecurity in those with weight loss.",
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Hanifa, Y, Toro Silva, S, Karstaedt, A, Sahid, F, Charalambous, S, Chihota, VN, Churchyard, GJ, von Gottberg, A, McCarthy, K, Nicol, MP, Ndlovu, NT, Stevens, W, Fielding, KL & Grant, AD 2019, 'What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations?' International Journal of Tuberculosis & Lung Disease, vol. 23, no. 2, pp. 157-165. https://doi.org/10.5588/ijtld.18.0251

What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations? / Hanifa, Y; Toro Silva, S; Karstaedt, A; Sahid, F; Charalambous, S; Chihota, V N; Churchyard, G J; von Gottberg, A; McCarthy, K; Nicol, M P; Ndlovu, N T; Stevens, W; Fielding, K L; Grant, A D.

In: International Journal of Tuberculosis & Lung Disease, Vol. 23, No. 2, 01.02.2019, p. 157-165.

Research output: Contribution to journalArticle

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T1 - What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations?

AU - Hanifa, Y

AU - Toro Silva, S

AU - Karstaedt, A

AU - Sahid, F

AU - Charalambous, S

AU - Chihota, V N

AU - Churchyard, G J

AU - von Gottberg, A

AU - McCarthy, K

AU - Nicol, M P

AU - Ndlovu, N T

AU - Stevens, W

AU - Fielding, K L

AU - Grant, A D

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Y1 - 2019/2/1

N2 - OBJECTIVETo identify the causes of symptoms suggestive of tuberculosis (TB) among people living with the human immunodeficiency virus (PLHIV) in South Africa.METHODSA 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.RESULTSAmong 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).CONCLUSIONPLHIV with persistent TB symptoms require further evaluation for TB using all available modalities, and for food insecurity in those with weight loss.

AB - OBJECTIVETo identify the causes of symptoms suggestive of tuberculosis (TB) among people living with the human immunodeficiency virus (PLHIV) in South Africa.METHODSA 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.RESULTSAmong 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).CONCLUSIONPLHIV with persistent TB symptoms require further evaluation for TB using all available modalities, and for food insecurity in those with weight loss.

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