University of Texas School of Public Health, Houston, Texas 77030, USA.
Int J Tuberc Lung Dis. 2011 Nov;15(11):1528-34, i. doi: 10.5588/ijtld.10.0777.
District 6, An Hoa Clinic in Ho Chi Minh City (HCMC), Viet Nam.
To evaluate the performance of various algorithms in tuberculosis (TB) screening and diagnosis in a human immunodeficiency virus (HIV) infected population in HCMC, Viet Nam.
A cross-sectional study of 397 consecutive HIV-infected patients seeking care at the An Hoa Clinic from August 2009 to June 2010. Data on participant demographics, clinical status, chest radiography (CXR) and laboratory results were collected. A multiple logistic regression model was developed to assess the association of covariates and pulmonary TB (PTB).
The prevalence of sputum culture-confirmed PTB, acid-fast bacilli (AFB) positive TB, and multidrugresistant TB among the 397 HIV-infected patients was respectively 7%, 2%, and 0.3%. Adjusted odds ratios for low CD4+ cell count, positive sputum smear, and CXR to positive sputum culture were respectively 3.17, 32.04 and 4.28. Clinical findings alone had poor sensitivity, but combining CD4+ cell count, AFB sputum smear and CXR had a more accurate diagnostic performance.
Results suggest that symptom screening had poor clinical performance, and support the routine use of sputum culture to improve the detection of TB disease in HIV-infected individuals in Viet Nam. However, when routine sputum culture is not available, an algorithm combining CD4+ cell count, AFB sputum smear and CXR is recommended for diagnosing PTB.
越南胡志明市第 6 区安和诊所。
评估各种算法在胡志明市艾滋病毒（HIV）感染人群中的结核病（TB）筛查和诊断中的表现。
2009 年 8 月至 2010 年 6 月，对在安和诊所就诊的 397 例连续 HIV 感染患者进行横断面研究。收集参与者的人口统计学、临床状况、胸部 X 线摄影（CXR）和实验室结果数据。建立了多变量逻辑回归模型，以评估协变量与肺 TB（PTB）的相关性。
397 例 HIV 感染患者中痰培养确诊 PTB、抗酸杆菌（AFB）阳性 TB 和耐多药 TB 的患病率分别为 7%、2%和 0.3%。CD4+细胞计数低、痰涂片阳性和 CXR 对阳性痰培养的调整比值比分别为 3.17、32.04 和 4.28。临床发现的敏感性较差，但将 CD4+细胞计数、AFB 痰涂片和 CXR 相结合具有更准确的诊断性能。
结果表明症状筛查的临床性能较差，支持常规使用痰培养来提高越南 HIV 感染者中 TB 疾病的检出率。然而，当常规痰培养不可用时，建议使用结合 CD4+细胞计数、AFB 痰涂片和 CXR 的算法来诊断 PTB。
