Gupta Aditi, Gadepalli Ravisekhar, Jain Vidhi, Abhishek Kumar S, Chauhan Nishant Kumar, Kumar Deepak
Department of Microbiology, AIIMS, Jodhpur, Rajasthan, India.
Department of Pulmonary Medicine, AIIMS, Jodhpur, Rajasthan, India.
Lung India. 2025 Jul 1;42(4):347-351. doi: 10.4103/lungindia.lungindia_639_24. Epub 2025 Jun 27.
Tuberculosis (TB) remains a leading cause of mortality among people living with HIV (PLHIV), with delayed diagnosis contributing significantly to poor outcomes. Early detection through systematic screening and diagnostic tools is essential to reduce morbidity and mortality in this high-risk population. This study aimed to evaluate the utility of the World Health Organization (WHO) four-symptom screen (fever, cough, weight loss, and night sweats), using Xpert MTB/RIF (Cepheid, Sunnyvale, California) as the gold standard for early detection of pulmonary TB in HIV-positive patients.
A total of 249 HIV-positive patients attending a tertiary care centre in Western India were screened using the WHO four-symptom tool. All patients, regardless of symptoms, underwent testing with Xpert MTB/RIF. Sensitivity, specificity, and predictive values were calculated for the symptom screen and individual symptoms. Univariate and multivariate analysis was performed to determine significance (P < 0.05).
The WHO four-symptom screen identified 40.2% of participants (n = 100) as screen-positive. Xpert MTB/RIF confirmed pulmonary TB in 5.6% (n = 14) of the total population. The combined sensitivity and specificity of the WHO symptom screen were 85.7% and 62.6%, respectively, with a high negative predictive value of 98.7%. Fever and cough were the most significant predictors (P < 0.05) in multivariate analysis.
The study highlights the importance of systematic TB screening among PLHIV using the WHO symptom tool in conjunction with molecular diagnostics. This approach facilitates early diagnosis and treatment, contributing to better health outcomes and aligns with global TB elimination strategies.
结核病（TB）仍然是艾滋病毒感染者（PLHIV）死亡的主要原因，诊断延迟是导致不良结局的重要因素。通过系统筛查和诊断工具进行早期检测对于降低这一高危人群的发病率和死亡率至关重要。本研究旨在评估世界卫生组织（WHO）的四项症状筛查（发热、咳嗽、体重减轻和盗汗）的效用，以Xpert MTB/RIF（赛沛公司，加利福尼亚州桑尼维尔）作为艾滋病毒阳性患者中早期检测肺结核的金标准。
使用WHO四项症状工具对印度西部一家三级护理中心的249名艾滋病毒阳性患者进行筛查。所有患者，无论有无症状，均接受Xpert MTB/RIF检测。计算症状筛查和各个症状的敏感性、特异性和预测值。进行单因素和多因素分析以确定显著性（P<0.05）。
WHO四项症状筛查将40.2%的参与者（n = 100）确定为筛查阳性。Xpert MTB/RIF在总人口的5.6%（n = 14）中确诊为肺结核。WHO症状筛查的综合敏感性和特异性分别为85.7%和62.6%，阴性预测值高达98.7%。发热和咳嗽在多因素分析中是最显著的预测因素（P<0.05）。
该研究强调了在PLHIV中使用WHO症状工具结合分子诊断进行系统性结核病筛查的重要性。这种方法有助于早期诊断和治疗，改善健康结局，并与全球结核病消除战略相一致。
