Evaluation of XpertMTB/Rif performance for diagnosis of tuberculosis among HIV positive patients in northern Tanzania

Abstract

Background: Diagnosis of tuberculosis (TB) in patients co-infected with HIV poses an important challenge because of the low sensitivity and specificity of microscopy, the standard diagnostic method. This study aimed to evaluate the performance of the XpertMTB/RIF tool for TB diagnosis among TB-HIV co-infected patients. Methods: This was a cross-sectional analytical study conducted at Kibong'oto Infectious Disease Hospital in northern Tanzania and involved 69 patients. The performance of the XpertMTB/RIF and microscopy using LJ culture were determined and compared. Demographic, clinical, laboratory and radiological data were collected. Results: XpertMTB/RIF had a higher sensitivity (100%), specificity (100%), positive predictive value (79.2%) and negative predictive value (98.9%) as compared to microscopy. There was a strong correlation between XpertMTB/RIF, microscopy and Löwenstein-Jensen (LJ) culture in terms of their sensitivity and specificity. Conclusion: While using TB symptoms screening tool alone in HIV infected individuals may result into overtreatment, relying on microscopy alone has the potential of TB under-diagnosing, miss-diagnosing and delayed treatment. Our results show XpertMTB/RIF to be highly sensitive and specific to detect all culture positive TB cases among HIV patients. We recommend the adoption of XpertMTB/RIF as an early TB diagnosis tool among HIV patients for early detection of TB among HIV patients.

Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults

“…We considered five studies (6%) to have high risk of bias because the results of the reference standard were not blinded ( Chaisson 2014 ; Hanif 2011 ; Safianowska 2012 ; Zeka 2011 ; Zmak 2013 ) and the remaining 12 studies (14%) to have unclear risk of bias because information about blinding was not reported. With respect to applicability (Reference Standard domain), we considered most studies to have low concern; we considered one study to have high concern because this study did not speciate mycobacteria isolated in culture ( Mollel 2017 ) and two studies (2%) to have unclear concern because we could not tell ( Adelman 2015 ; Barmankulova 2015 ).…”

“…In addition, we considered 15 studies (17%) to have unclear risk of bias because the manner of participant selection was not stated (Atwebembeire 2016; Barmankulova 2015; Bates 2013a; Boum 2016; Chen 2017; Huang 2015; Kim CH 2015; Luetkemeyer 2016; Mbelele 2017; Moussa 2016; Mutingwende 2015; Nosova 2013a; Reechaipichitkul 2017; Shao 2017; Shenai 2016). With respect to applicability, we considered 46 studies (53%) to have low concern because participants in these studies were evaluated in primary care facilities, local hospitals, or both settings (Adelman 2015; Al‐Darraji 2013; Balcells 2012; Balcha 2014; Barmankulova 2015; Bjerrum 2016; Boehme 2010; Boehme 2011; Boum 2016; Calligaro 2017; Carriquiry 2012; Chen 2017; Dorman 2018; Friedrich 2011; Hanrahan 2013; Hanrahan 2014; Henostroza 2016; Huang 2015; Kurbaniyazova 2017; Kurbatova 2013; Kwak 2013; LaCourse 2016; Lawn 2011; Luetkemeyer 2016; Meawed 2016; Metcalfe 2015; Mollel 2017; Moure 2011; Mutingwende 2015; Ngabonziza 2016; Nliwasa 2016; O'Donnell 2015; Pimkina 2015; Reddy 2017; Rice 2017; Scott 2011; Scott 2017; Shao 2017; Shenai 2016; Sohn 2014; Ssengooba 2014; …”

“…We included 70 studies involving 37,237 unselected participants (Adelman 2015; Al‐Darraji 2013; Atwebembeire 2016; Balcells 2012; Balcha 2014; Barmankulova 2015; Bates 2013a; Bjerrum 2016; Boehme 2010; Boehme 2011; Boum 2016; Calligaro 2015; Calligaro 2017; Carriquiry 2012; Chaisson 2014; Chen 2017; Chew 2016; Cowan 2017; Davis 2014; Dorman 2018; Geleta 2015; Hanif 2011; Hanrahan 2013; Hanrahan 2014; Helb 2010; Henostroza 2016; Huang 2015; Huh 2014; Kawkitinarong 2017; Kim CH 2015; Ko 2016; Kurbaniyazova 2017; Kurbatova 2013; Kwak 2013; LaCourse 2016; Lawn 2011; Lippincott 2014; Liu 2017; Luetkemeyer 2016; Mbelele 2017; Mollel 2017; Moussa 2016; Mutingwende 2015; Ngabonziza 2016; Nikam 2014; Nliwasa 2016; Nosova 2013a; O'Donnell 2015; Park 2013; Pinyopornpanish 2015; Rachow 2011; Reddy 2017; Reechaipichitkul 2017; Rice 2017; Safianowska 2012; Sah 2017; Scott 2011; Scott 2017; Shao 2017; Sharma 2015; Shenai 2016…”

Efetividade do GeneXpert® no diagnóstico da tuberculose em pessoas que vivem com HIV/aids

“…Dos 19 artigos incluídos nessa revisão, 18 (94,7%) foram publicados em língua inglesa 6,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] e um (5,3%) em língua espanhola 39 , dos quais 15 (78,9%) são procedentes do Continente Africano 6,22,23,[25][26][27][28][29][30][31][32][33][34]36,38 , dois (10,5%), do Continente Americano 37,39 , um (5,3%), do Continente Asiático 24 e um (5,3%) estudo multicêntrico 35 envolve países da África, América, Europa e Ásia.…”

Improved performance of Xpert MTB/RIF assay on sputum sediment samples obtained from presumptive pulmonary tuberculosis cases at Kibong’oto infectious diseases hospital in Tanzania

“…The commonly applied protocol for detecting MTB in Xpert at our hospital and in most other settings is the use of raw sputum to Xpert sample reagent (SR) with a ratio of 1:2 [ 10 , 12 ]. The SR contains 2% of sodium hydroxide (NaoH) and isopropanol.…”