Tuberculosis in people newly diagnosed with HIV at a large HIV care and treatment center in Northwest Cameroon: burden, comparative screening and diagnostic yields, and patient outcomes

Background Diagnosis of tuberculosis in people living with HIV is challenging due to non-specific clinical presentations and inadequately sensitive diagnostic tests. The WHO recommends screening using a clinical algorithm followed by rapid diagnosis using the Xpert MTB/RIF assay, and more information is needed to evaluate these recommendations in different settings. Methods From August 2012 to September 2013, consecutive adults newly diagnosed with HIV in Bamenda, Cameroon, were screened for TB regardless of symptoms by smear microscopy and culture; the Xpert MTB/RIF assay was performed retrospectively. Time to treatment and patient outcomes were obtained from routine registers. Results Among 1,149 people enrolled, 940 (82%) produced sputum for lab testing; of these, 68% were women, the median age was 35 years (IQR, 28-42 years), the median CD4 count was 291cells/µL (IQR, 116-496 cells/µL), and 86% had one or more of current cough, fever, night sweats, or weight loss. In tota...背景 人类免疫缺陷病毒（HIV，Human Immunodeficiency Virus）感染者的结核病诊断颇具挑战，其临床表现缺乏特异性，且现有诊断试剂的灵敏度存在不足。世界卫生组织（WHO，World Health Organization）推荐先采用临床算法开展筛查，随后通过Xpert MTB/RIF检测进行快速诊断，但目前仍需更多研究数据以评估该推荐方案在不同场景下的适用性。 方法 2012年8月至2013年9月期间，研究纳入喀麦隆巴门达地区连续就诊的新发HIV感染成人受试者，无论是否存在临床症状，均采用涂片镜检与分枝杆菌培养法进行结核病筛查；同时对受试者样本回溯性开展Xpert MTB/RIF检测。受试者的抗结核治疗启动时间与临床转归情况均从常规诊疗登记系统中提取。 结果 本研究共纳入1149名受试者，其中940名（82%）成功留取痰液标本用于实验室检测；该940名合格受试者中，女性占比68%，年龄中位数为35岁（四分位间距（Interquartile Range, IQR）：28~42岁），CD4细胞计数中位数为291个/微升（IQR：116~496个/微升），86%的受试者存在咳嗽、发热、盗汗或体重减轻中的至少一种症状。总计...