Evaluation of the 2007 WHO Guideline to Improve the Diagnosis of Tuberculosis in Ambulatory HIV-Positive AdultsReportar como inadecuado

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In 2007 WHO issued a guideline to improve the diagnosis of smear-negative and extrapulmonary tuberculosis EPTB in HIV-positive patients. This guideline relies heavily on the acceptance of HIV-testing and availability of chest X-rays.

Methods and Findings

Cohort study of TB suspects in four tuberculosis TB clinics in Phnom Penh, Cambodia. We assessed the operational performance of the guideline, the incremental yield of investigations, and the diagnostic accuracy for smear-negative tuberculosis in HIV-positive patients using culture positivity as reference standard. 1,147 68.9% of 1,665 TB suspects presented with unknown HIV status, 1,124 98.0% agreed to be tested, 79 7.0% were HIV-positive. Compliance with the guideline for chest X-rays and sputum culture requests was 97.1% and 98.3% respectively. Only 35 of 79 HIV-positive patients 44.3% with a chest X-ray suggestive of TB started TB treatment within 10 days. 105 of 442 HIV-positive TB suspects started TB treatment 56.2% smear-negative pulmonary TB PTB, 28.6% smear-positive PTB, 15.2% EPTB. The median time to TB treatment initiation was 5 days IQR: 2–13 days, ranging from 2 days IQR: 1–11.5 days for EPTB, over 2.5 days IQR: 1–4 days for smear-positive PTB to 9 days IQR: 3–17 days for smear-negative PTB. Among the 34 smear-negative TB patients with a confirmed diagnosis, the incremental yield of chest X-ray, clinical suspicion or abdominal ultrasound, and culture was 41.2%, 17.6% and 41.2% respectively. The sensitivity and specificity of the algorithm to diagnose smear-negative TB in HIV-positive TB suspects was 58.8% 95%CI: 42.2%–73.6% and 79.4% 95%CI: 74.8%–82.4% respectively.


Pending point-of-care rapid diagnostic tests for TB disease, diagnostic algorithms are needed. The diagnostic accuracy of the 2007 WHO guideline to diagnose smear-negative TB is acceptable. There is, however, reluctance to comply with the guideline in terms of immediate treatment initiation.

Autor: Olivier Koole , Sopheak Thai, Kim Eam Khun, Reaksmey Pe, Johan van Griensven, Ludwig Apers, Jef Van den Ende, Tan Eang Mao, Lutga

Fuente: http://plos.srce.hr/


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