Objective We sought to determine the accuracy and role of rapid C-reactive protein (CRP) testing in HIV-infected tuberculosis suspects. Design We enrolled HIV-infected adults (≥18 years) with a cough for ≥2 weeks and negative sputum smears for acid-fast bacilli (AFB) in KwaZulu-Natal, South Africa. Participants were evaluated for pulmonary tuberculosis by a nurse with rapid CRP, and independently by a physician with a chest radiograph. Rapid CRP test results were compared to laboratory CRP and sputum sent for confirmation of tuberculosis. Results Among 93 participants, 55 (59%) were female, mean age was 35 years, and median CD4 count was 177/mm3. Forty-five (54%) participants were diagnosed with pulmonary tuberculosis. Diagnostic sensitivity and specificity were 95% (95% CI 74–99%) and 51% (95% CI 35–66%) for rapid CRP > 8 mg/l, 87% (95% CI 73–96%) and 53% (95% CI 38–68%) for nurse assessment, and 69% (95% CI 52–83%) and 76% (95%CI 61–87%) for physician examination. Combining a positive rapid CRP (> 8 mg/l) to nurse and physician assessments decreased post- test probability of pulmonary tuberculosis from 22% to 6% and 32% to 6%, respectively. Conclusion Rapid CRP testing helped exclude pulmonary tuberculosis, and may be a valuable test to assist nurses and physicians in tuberculosis-endemic regions.
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