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GeneXpert® 在诊断 HIV/AIDS 患者结核病中的有效性。

Effectiveness of GeneXpert® in the diagnosis of tuberculosis in people living with HIV/AIDS.

机构信息

Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Programa de Pós-Graduação em Saúde Pública. Ribeirão Preto, SP, Brasil.

Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Departamento Materno-Infantil e Saúde Pública. Ribeirão Preto, SP, Brasil.

出版信息

Rev Saude Publica. 2021 Dec 17;55:89. doi: 10.11606/s1518-8787.2021055003125. eCollection 2021.

Abstract

OBJECTIVE

To identify and synthesize the scientific knowledge produced regarding the effectiveness of the GeneXpert test in the diagnosis of pulmonary tuberculosis (TB) in people living with HIV/AIDS.

METHODS

Integrative literature review, which was searched on Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex, and LILACS platforms, in December 2019. The studies surveyed went through two stages of selection: reading of titles and abstracts by two reviewers independently; using the Rayyan platform and reading. Nineteen primary studies in English, Portuguese, and Spanish that answered the study's guiding question were included: How effective is the GeneXpert test in the diagnosis of pulmonary TB in people living with HIV/AIDS?

RESULTS

The use of GeneXpert substantially increased the detection of TB cases among the population co-infected with HIV/AIDS, with sensitivity ranging from 68% to 100%, superior to sputum smear microscopy. Specificity ranged from 91.7% to 100%; the positive predictive value from 79.2% to 96.1%; and the negative predictive value from 84.6% to 99.3%. These values were considered similar to sputum smear microscopy by most studies. We also compared these results with different ways of performing culture and other molecular tests, being considered inferior only to the Xpert Ultra.

CONCLUSION

It is possible to affirm that places with a high incidence of HIV/AIDS would benefit from the implementation of the GeneXpert test, entailing effectiveness in diagnosing pulmonary TB in this population when compared to sputum smear microscopy, a widely used test for detection of cases.

摘要

目的

确定并综合分析有关 GeneXpert 检测在诊断 HIV/AIDS 患者肺结核(TB)方面的有效性的科学知识。

方法

综合文献回顾,于 2019 年 12 月在 Embase、Scopus、PubMed、Cinahl、Academic Search Premier、Socindex 和 LILACS 平台上进行检索。对经过两位评审员独立阅读标题和摘要、使用 Rayyan 平台和全文阅读的 2 个阶段筛选的研究进行调查。共纳入 19 项英文、葡萄牙文和西班牙文的原始研究,这些研究回答了研究的指导问题:GeneXpert 检测在诊断 HIV/AIDS 患者肺结核方面的效果如何?

结果

GeneXpert 的使用显著提高了 HIV/AIDS 合并感染者中结核病病例的检出率,其灵敏度为 68%至 100%,优于痰涂片显微镜检查。特异性为 91.7%至 100%;阳性预测值为 79.2%至 96.1%;阴性预测值为 84.6%至 99.3%。大多数研究认为这些值与痰涂片显微镜检查相似。我们还将这些结果与不同的培养方法和其他分子检测进行了比较,与 Xpert Ultra 相比,GeneXpert 的效果稍差。

结论

可以肯定的是,HIV/AIDS 高发地区将受益于 GeneXpert 检测的实施,与广泛用于检测病例的痰涂片显微镜检查相比,该检测在诊断该人群的肺结核方面具有有效性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3c9/8664060/28bd4bc870d6/1518-8787-rsp-55-89-gf01.jpg

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