Gupta R.K., Lawn S.D., Bekker L.-G., Caldwell J., Kaplan R., Wood R.
Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; City of Cape Town Department of Health, Cape Town, South Africa
Gupta, R.K., Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa; Lawn, S.D., Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Bekker, L.-G., Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa; Caldwell, J., City of Cape Town Department of Health, Cape Town, South Africa; Kaplan, R., Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa; Wood, R., Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
BACKGROUND: The impact of human immunodeficiency virus (HIV) infection and CD4 count on the diagnosis of tuberculosis (TB) at population level is incompletely defined. OBJECTIVE: To determine how HIV infection and CD4 count affect disease site, sputum smear status and overall rate of laboratory confirmation (sputum smear microscopy or culture) of TB cases under routine programme conditions. DESIGN: Retrospective analysis of the 2009 electronic TB register for Cape Town, South Africa. RESULTS: Of 29 478 TB cases notified in 2009, HIV status was known for 25 744 (87.3%) cases, of whom 13 237 (51.4%) were HIV-positive. Of these, 61.2% had CD4 cell counts of <200 cells/μl and 82.7% had counts of <350 cells/μl. Laboratory confirmation of TB (by smear or culture) was obtained less frequently in HIV-infected than non-HIV-infected adult cases (53.9% vs. 74.3%, P < 0.001). HIV infection was associated with a higher proportion of sputum smear-negative and extrapulmonary TB and lower grades of sputum smear positivity even among those with CD4 counts of ≥500 cells/ μl. However, the relationship between the proportion of smear-positive cases and CD4 count was non-linear. CONCLUSION: Much TB is not laboratory-confirmed in this setting despite good laboratory services. HIV-associated TB is more difficult to diagnose even at high CD4 cell counts of >500 cells/μl, suggesting early impact after HIV seroconversion. © 2013 The Union.
adolescent; adult; article; bacterium culture; CD4 lymphocyte count; child; controlled study; extrapulmonary tuberculosis; female; human; Human immunodeficiency virus infection; infant; laboratory diagnosis; lung tuberculosis; major clinical study; male; microscopy; preschool child; priority journal; retrospective study; school child; South Africa; sputum smear; tuberculin test; tuberculosis; Adolescent; Adult; CD4 Lymphocyte Count; Child; Child, Preschool; Female; HIV Infections; Humans; Infant; Male; Middle Aged; Nonlinear Dynamics; Registries; Retrospective Studies; South Africa; Sputum; Tuberculosis; Young Adult
Wellcome Trust Diseases; 5 R01AI058736-02, NIH, National Institutes of Health Development Right to Care