Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Int J Tuberc Lung Dis. 2021 Jun 1;25(6):427-435. doi: 10.5588/ijtld.21.0049.
Systematic screening for active TB is recommended for all people living with HIV (PLWH); however, case detection remains poor globally. We investigated the yield of active case finding (ACF) by calculating the number needed to screen (NNS) to detect a case of active TB among PLWH. We identified studies reporting ACF for TB among PLWH published from November 2010 to February 2020. We calculated crude NNS for Xpert- or culture-confirmed TB and weighted mean NNS stratified by screening approach, population/risk group, and country TB burden. Of the 27,221 abstracts screened, we identified 58 studies eligible for inclusion, including 5 in low/moderate TB incidence settings and 53 in medium/high incidence settings. Populations screened for TB included inpatients, outpatients not receiving antiretroviral therapy (ART), outpatients receiving ART, those with CD4 < 200 cells/µL, children aged ≤15 years, pregnant PLWH, and PLWH in prisons. Screening tools included symptom-based screening, chest X-ray, C-reactive protein levels, and Xpert. The weighted mean NNS varied across groups but was consistently low, ranging from 4 among inpatients in moderate/high TB burden settings to 137 among pregnant PLWH in moderate/high TB burden settings. ACF is a high yield intervention among PLWH. Approaches to screening should be tailored to local epidemiological and health-system contexts, and sensitive screening tools such as Xpert should be implemented where feasible.
系统筛查所有 HIV 感染者（PLWH）中的活动性结核病（TB）；然而，全球范围内的病例检出率仍然较低。我们通过计算筛查发现活动性结核病（ACF）的数量（NNS）来评估 PLWH 中活动性结核病的检出率。我们检索了 2010 年 11 月至 2020 年 2 月发表的关于 PLWH 中结核病 ACF 的研究。我们计算了 Xpert 或培养确诊结核病的粗 NNS，并按筛查方法、人群/风险组和国家结核病负担分层加权平均 NNS。在筛选的 27221 篇摘要中，我们确定了 58 项符合纳入标准的研究，其中 5 项研究来自结核病发病率较低/中等的国家，53 项研究来自结核病发病率较高的国家。筛查的结核病人群包括住院患者、未接受抗逆转录病毒治疗（ART）的门诊患者、接受 ART 的门诊患者、CD4 细胞<200 个/μL 的患者、≤15 岁的儿童、孕妇和监狱中的 PLWH。筛查工具包括基于症状的筛查、胸部 X 线、C 反应蛋白水平和 Xpert。加权平均 NNS 在不同组中有所不同，但始终较低，从中等/高结核病负担环境中的住院患者中的 4 例到中等/高结核病负担环境中的孕妇 PLWH 中的 137 例。ACF 是一种在 PLWH 中具有高检出率的干预措施。筛查方法应根据当地的流行病学和卫生系统情况进行调整，应在可行的情况下实施 Xpert 等敏感的筛查工具。
