Department of Epidemiology, Biostatistics and Occupational Health.
McGill International TB Centre, McGill University, Montreal, Canada.
Curr Opin HIV AIDS. 2019 Jan;14(1):46-54. doi: 10.1097/COH.0000000000000512.
Diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) remains a challenge, despite it being the most common comorbidity in this group. In this review, we provide an overview of tests for active TB, and their diagnostic performance in PLHIV.
New and updated diagnostic tests have better performance than traditional bacterial culture or smear microscopy in PLHIV. Recent developments in molecular tests have improved the sensitivity at which TB and drug susceptibility can be detected in PLHIV. Notably, the updated Xpert Ultra test can detect HIV-associated TB with high sensitivity, and a rapid lateral flow lipoarabinomannan-based assay has been shown to reduce TB-related mortality in hospitalized PLHIV. New directions in drug-susceptibility testing are being pursued, such as next-generation sequencing and line probe assays, but more evaluation in PLHIV is needed. There is growing understanding of subclinical TB, but methods to detect this type of TB are inadequate.
As diagnosis is the weakest link in the TB care cascade, newer more accurate TB tests must be scaled up and fully integrated into existing healthcare systems. Drug-susceptibility testing must become universal to ensure appropriate treatment regimens are prescribed, allowing TB clearance and inhibiting development of antimicrobial resistance.
尽管结核病（TB）是 HIV 感染者（PLHIV）中最常见的合并症，但在该人群中诊断结核病仍然具有挑战性。在本篇综述中，我们概述了用于诊断活动性结核病的检测方法及其在 PLHIV 中的诊断性能。
与传统的细菌培养或涂片显微镜检查相比，新型和更新的诊断检测方法在 PLHIV 中的性能更好。分子检测的最新进展提高了检测 TB 和药物敏感性的灵敏度。值得注意的是，更新的 Xpert Ultra 检测可高度灵敏地检测与 HIV 相关的结核病，并且快速侧向流动脂阿拉伯甘露聚糖检测已被证明可降低住院 PLHIV 的结核病相关死亡率。正在探索新的药物敏感性检测方法，如下一代测序和线探针检测，但需要在 PLHIV 中进行更多的评估。人们对亚临床结核病的认识不断加深，但检测这种类型结核病的方法还不够完善。
由于诊断是结核病防治工作中最薄弱的环节，因此必须扩大新型、更准确的结核病检测方法的规模，并将其完全纳入现有的医疗保健系统中。必须进行药物敏感性检测，以确保开具适当的治疗方案，清除结核病并抑制抗微生物药物耐药性的发展。
