Abstract
Background: Xpert MTB/Rif (Xpert) is described as a game changer in tuberculosis (TB) control. We evaluated the impact of Xpert on diagnosis, time to treatment, and treatment outcome among patients with HIV associated TB in Nigeria. Methods: Adults with HIV being evaluated for pulmonary TB (PTB) were consecutively enrolled into the study cohort. At baseline, expectorated sputa were examined using Xpert and smear microscopy for Mycobacterium tuberculosis (MTB) and acid fast bacilli, respectively. Patients diagnosed with TB were followed-up until 6 months post TB diagnosis. TB was defined as sputum positive by smear microscopy, Xpert detection of MTB (bacteriologically confirmed case), or clinician diagnosed TB with initiation of full TB treatment (clinical diagnosis). Time to treatment was time from first clinic presentation for TB evaluation to initiation of TB treatment. We examined the proportion PTB patients with a positive Xpert result and compared time to TB treatment and outcome of TB treatment in patients based on sputum test results. Results: A total of 310 adults with HIV were enrolled. The median CD4 cell count was 242 (interquartile range (IQR) 120-425) cells/mm3 and 88.1% were receiving antiretroviral therapy (ART). PTB was diagnosed in 76 (24.5%) patients, with 71 (93.4%) being bacteriologically confirmed. Among patients with PTB, 56 (73.7%) were Xpert positive. Median time to treatment was 5 (IQR 2-8) days and 12 (IQR 5-35) days in patient with and without Xpert positive results, respectively; p = 0.005. Overall 73.1% had symptom free survival at 6 months post PTB treatment initiation with no significant differences observed based on TB test method. 10 (14.9%) died within 6 months of TB treatment initiation. In analysis adjusted for age, sex, and mode of diagnosis (Xpert positive or negative), only ART use independently predicted mortality (AOR 0.10; 95% CI 0.01-0.93). Conclusion: The use of Xpert for routine care reduced time to PTB treatment, but did not improve survival in patients with HIV treated for susceptible PTB.
| Original language | English (US) |
|---|---|
| Article number | 87 |
| Journal | BMC Pulmonary Medicine |
| Volume | 17 |
| Issue number | 1 |
| DOIs | |
| State | Published - May 30 2017 |
Funding
MOA was supported by the NIH through the Fogarty International Center grants 1D43TW009575 and D43TWOO7995 (R.L.M as PI). The funding agencies had no role in the design of the study, data collection or analysis, interpretation of data, or in writing the manuscript. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Fogarty International Center or the National Institutes of Health. The JUTH HIV treatment program commenced with support from the Government of Nigeria and the Bill & Melinda Gates Foundation in 2002. Subsequent support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in 2004 expanded access to free antiretroviral therapy (ART). At the time of this study approximately 10,000 patients were receiving comprehensive HIV care, which included treatment of opportunistic infections such as TB.
Keywords
- Africa
- HIV
- Nigeria
- Outcomes research
- Tuberculosis
- Xpert
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
