High Prevalence Of Subclinical Tuberculosis In HIV-1 Infected Persons Without Advanced Immunodeficiency: Implications For TB Screening ToluONI Imperial College London University of Cape Town 20 June 2011 Abstract no.WEPDB0206
INTRODUCTION AIM METHODS Setting: Khayelitsha Participants: - 274 asymptomatic persons from pre-ART wellness clinic or at HCT (+162 symptomatic TB cases for comparison) TB screening, Tuberculin skin test (TST), CXR if TST >4mm Spoligotyping • To describe the prevalence and outcome of subclinical TB disease in HIV-1-infected persons not eligible for ART.
KEY FINDINGS • 8.5% (95% C.I. 5.1-13.0%) prevalence of asymptomatic TB disease, with good clinical outcomes • Spoligotyping effectively excludes cross-contamination • 71% of those with TST ≥ 5mm had normal CXR • Findings suggest lower bacterial burden compared to symptomatic TB cases • 56% progressed clinically, median 28 days later • Suggests increasing bacterial load and actively replicating bacilli • Treatment received earlier with potential public health significance (22% smear positive)
POLICY IMPLICATIONS • Results suggest that in high HIV/TB transmission settings, HIV-1 infection should prompt a TB test by sputum culture especially in persons with -TST ≥5mm (OR 4.96; p=0.064) - lower CD4 counts (OR 0.996; p=0.06) - longer history of HIV (OR 1.006; p=0.056) • Highlights need for new rapid and affordable point-of-care diagnostic tests to identify persons with clinical and subclinical TB disease.
ACKNOWLEDGMENTS • Lebo Tsekela • Hannah Gideon • NonzwakaziBangani • RonnettSeldon • Rachael Burke • Kathryn Wood • Katalin Wilkinson • Tom Ottenhoff • Robert Wilkinson • Study Participants