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BMC Infect Dis. 2019 Jan 5;19(1):14. doi: 10.1186/s12879-018-3614-7.

Subclinical tuberculosis among adults with HIV: clinical features and outcomes in a South African cohort.

Author information

1
Department of Medicine, University of Washington, 1959 NE Pacific St., Box 356429, Seattle, WA, 98195, USA. kbajema@uw.edu.
2
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston University School of Public Health, Boston, USA.
3
Boston University School of Public Health, Boston, USA.
4
Department of Medicine, St. Mary's Hospital, Durban, South Africa.
5
Departments of Medicine, Epidemiology, and Laboratory Medicine, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, USA.
6
Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, USA.
7
Departments of Surgery and Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Abstract

BACKGROUND:

Subclinical tuberculosis is an asymptomatic disease phase with important relevance to persons living with HIV. We describe the prevalence, clinical characteristics, and risk of mortality for HIV-infected adults with subclinical tuberculosis.

METHODS:

Untreated adults with HIV presenting for outpatient care in Durban, South Africa were screened for tuberculosis-related symptoms and had sputum tested by acid-fast bacilli smear and tuberculosis culture. Active tuberculosis and subclinical tuberculosis were defined as having any tuberculosis symptom or no tuberculosis symptoms with culture-positive sputum. We evaluated the association between tuberculosis disease category and 12-month survival using Cox regression, adjusting for age, sex, and CD4 count.

RESULTS:

Among 654 participants, 96 were diagnosed with active tuberculosis disease and 28 with subclinical disease. The median CD4 count was 68 (interquartile range 39-161) cells/mm3 in patients with active tuberculosis, 136 (72-312) cells/mm3 in patients with subclinical disease, and 249 (125-394) cells/mm3 in those without tuberculosis disease (Pā€‰<ā€‰0.001). The proportion of smear positive cases did not differ significantly between the subclinical (29%) and active tuberculosis groups (14%, P 0.08). Risk of mortality was not increased in individuals with subclinical tuberculosis relative to no tuberculosis (adjusted hazard ratio 0.84, 95% confidence interval 0.26-2.73).

CONCLUSIONS:

Nearly one-quarter of tuberculosis cases among HIV-infected adults were subclinical, which was characterized by an intermediate degree of immunosuppression. Although there was no significant difference in survival, anti-tuberculous treatment of subclinical cases was common.

TRIAL REGISTRATION:

Prospectively registered on ClinicalTrials.gov , NCT01188941 (August 26, 2010).

KEYWORDS:

AIDS-related opportunistic infections; Disease progression; HIV; Subclinical infections; Tuberculosis

PMID:
30611192
PMCID:
PMC6321698
DOI:
10.1186/s12879-018-3614-7
[Indexed for MEDLINE]
Free PMC Article

Publication type, MeSH terms, Substances, Secondary source ID, Grant support

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