GeneXpert on patients with human immunodeficiency virus and smear-negative pulmonary tuberculosis.

Nguyen Kim Cuong,Vu Quoc Dat,Nguyen Bao Ngoc,Nguyen Viet Nhung,Nguyen Binh Hoa,Shampa Anupurba

doi:10.1371/journal.pone.0253961

Nguyen Kim Cuong, Vu Quoc Dat + Show 4 more

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https://doi.org/10.1371/journal.pone.0253961

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Journal: PloS one	Publication Date: Jul 6, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: Hanoi Medical University, Hanoi Lung Hospital

Abstract

ObjectivesVietnam is a high-prevalence country for tuberculosis (TB). Xpert MTB/RIF is a novel PCR-based diagnostic test that is substantially more sensitive for detecting M. tuberculosis than traditional smear-based techniques. However, locally-derived evidence of Xpert MTB/RIF in HIV-infected people is limited. This study evaluates the performance of the Xpert MTB/RIF in HIV-infected patients with smear-negative pulmonary TB (SNTB).MethodsThis was a cross-sectional study in 3 hospitals. The performance of Xpert MTB/RIF was compared with the reference standard of liquid culture and phenotypic drug-susceptibility testing for rifampicin (RIF) resistance.ResultsOut of 123 patients, the median age was 37.0 (IQR: 32.0–41.0) and 81.3% were male. The area under the receiver operating characteristic curve, sensitivity (Se) and specificity (Sp) of Xpert MTB/RIF for pulmonary TB diagnosis were 0.72 (95% confidence interval [CI]: 0.63–0.81), 66.7% (95%CI: 54.8–77.1) and 77.1% (95%CI: 62.7–88.0), respectively, while Se and Sp of Xpert MTB/RIF in detecting RIF resistance were 50.0 (11.8–88.2) and 86.4% (95%CI: 72.7–94.8).ConclusionThe performance of Xpert MTB/RIF in HIV-infected patients with SNTB for the diagnosis of TB and RIF-resistance was low. Further studies are required to evaluate the results of Xpert MTB/RIF assay in HIV-infected patients with SNTB and the role of Xpert repetition on the same specimens.

Highlights

Tuberculosis (TB) is the globally leading cause of death among people living with human immunodeficiency virus (HIV), accounting for 1.2 million TB-related mortalities among seronegative persons and 208,000 deaths among HIV-infected patients [1]
MTB/RIF assay in HIV-infected patients with smear-negative pulmonary TB (SNTB) and the role of Xpert repetition on the same specimens
While culture remains the gold standard for TB diagnosis, Xpert MTB/RIF is recommended as the initial test for TB in HIV-infected patients because its sensitivity is substantially higher than that of acid-fast bacilli (AFB) smear [3, 4]

Summary

Introduction

Tuberculosis (TB) is the globally leading cause of death among people living with human immunodeficiency virus (HIV), accounting for 1.2 million TB-related mortalities among seronegative persons and 208,000 deaths among HIV-infected patients [1]. The World Health Organization (WHO) estimated that among 10.0 million (range, 9.0–11.1 million) TB cases, the proportion of HIV-infected patients were 8.2% [1]. TB remains the leading cause of death among HIV-infected patients, accounting for around one in three AIDS-related deaths [2]. Chest X-ray, acid-fast bacilli (AFB) smear, Xpert MTB/RIF, and culture are the most frequent laboratory methods to detect TB. While culture remains the gold standard for TB diagnosis, Xpert MTB/RIF is recommended as the initial test for TB in HIV-infected patients because its sensitivity is substantially higher than that of AFB smear [3, 4]

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