Mbah Henry A, Jegede Feyisayo E, Abdulrahman Surajudeen A, Oyeyi Tinuade I
LabTrail Global LLC, Smyrna, Delaware, United States.
Biological Science Department, Bayero University Kano, Gwarzo Road Kano, Nigeria.
Afr J Lab Med. 2018 Dec 5;7(1):698. doi: 10.4102/ajlm.v7i1.698. eCollection 2018.
Malaria diagnosis among HIV-positive patients is uncommon in Nigeria despite the high burden of both diseases.
We evaluated the performance of a malaria rapid diagnostic test (MRDT) against blood smear microscopy (BSM) among HIV-positive patients in relation to anti-retroviral treatment (ART) status, CD4+ count, fever, cotrimoxazole prophylaxis and malaria density count.
A cross-sectional study involving 1521 consenting randomly selected HIV-positive adults attending two ART clinics in Kano, Nigeria, between June 2015 and May 2016. Venous blood samples were collected for testing with MRDT, BSM, and CD4+ T cells count by cytometry. Biodata and other clinical details were extracted from patient folders into an Excel file, cleaned, validated, and exported for analysis into SPSS version 23.0. Sensitivity, specificity, predictive values of MRDT were compared with BSM with a 95% confidence interval.
Malaria parasites were detected in 25.4% of enrollees by BSM and 16.4% by MRDT. Overall sensitivity of MRDT was 58% and specificity was 97%. Cotrimoxazole prophylaxis and fever status did not affect MRDT sensitivity and specificity. Unexpectedly, the sensitivity was highest at parasite density count of less than 500 cells/µL. At CD4+ T cells count over 500 cells/µL the sensitivity was higher (62.4%) compared to 56% at less than 500 cells/µL. In the non-ART group sensitivity was higher (65%) compared to those on ART (56%) but the specificity was similar. All differences were significant for all variables ( < 0.05).
Although the MRDT specificity was good, the sensitivity was poor, requiring further evaluation for use in malaria diagnosis among HIV-malaria co-infected persons in these settings.
尽管尼日利亚同时面临着疟疾和艾滋病的高负担，但在艾滋病毒阳性患者中进行疟疾诊断的情况并不常见。
我们评估了疟疾快速诊断试验（MRDT）相对于血涂片显微镜检查（BSM）在艾滋病毒阳性患者中的性能，该评估与抗逆转录病毒治疗（ART）状态、CD4 + 细胞计数、发热、复方新诺明预防用药以及疟原虫密度计数有关。
2015年6月至2016年5月期间，在尼日利亚卡诺的两家抗逆转录病毒治疗诊所，对1521名随机选取的同意参与研究的艾滋病毒阳性成年患者进行了一项横断面研究。采集静脉血样本，用于MRDT检测、BSM检测以及通过流式细胞术进行CD4 + T细胞计数。从患者病历中提取生物数据和其他临床细节，录入Excel文件，进行清理、验证，然后导出到SPSS 23.0版本中进行分析。将MRDT的敏感性、特异性、预测值与BSM进行比较，并给出95%置信区间。
通过BSM在25.4%的受试者中检测到疟原虫，通过MRDT检测到的比例为16.4%。MRDT的总体敏感性为58%，特异性为97%。复方新诺明预防用药和发热状态不影响MRDT的敏感性和特异性。出乎意料的是，在疟原虫密度计数低于500个细胞/微升时，敏感性最高。在CD4 + T细胞计数超过500个细胞/微升时，敏感性较高（62.4%），而低于500个细胞/微升时为56%。在未接受抗逆转录病毒治疗的组中，敏感性较高（65%），高于接受抗逆转录病毒治疗的组（56%），但特异性相似。所有变量的所有差异均具有统计学意义（P < 0.05）。
尽管MRDT的特异性良好，但敏感性较差，在这些环境中，对于艾滋病毒与疟疾合并感染人群的疟疾诊断应用，仍需要进一步评估。
