Title: Comparative Study of Cartridge Based Nucleotide Amplification Test (CBNAAT) Versus Sputum Microscopy for the Diagnosis of Pulmonary Tuberculosis in People living with HIV and its Correlation with CD4 Count
Authors: Dr Kavya S T, Dr Saicharan G Chitrak, Dr. Stephen Benny, Dr Yaduraj D K
DOI: https://dx.doi.org/10.18535/jmscr/v9i6.43
Abstract
Background: Diagnosis of tuberculosis is a challenge on its own, more so in HIV-infected individuals. The Xpert MTB/RIF assay has recently replaced sputum microscopy as the investigation of choice in People living with HIV (PLHIV). The present study aims to compare two methods for the diagnosis of TB in PLHIV: Microscopy, and Xpert MTB/RIF. and to compare with CD4 count
Objective of the Study
- To compare between efficacy of CBNAAT and sputum microscopy in detection of pulmonary tuberculosis in HIV patients.
- To detect the prevalence of rifampicin resistance and MDR TB in HIV patients
Methods: Study was conducted on HIV patients consulted at hospitals attached to Bangalore medical college and research institute, during the period of November 1st 2018 to August 30th 2020 were taken for study, considering the inclusion and exclusion criteria. Detailed clinical history, examination and investigations viz, sputum microscopy ,CBNAAT,CD4 count was done for every patients.
Results: After analysis of the data it was found that CBNAAT was more effective in detecting tuberculosis in PLHIV, when compared to conventional sputum microscopy. Sensitivity of CBNAAT was positively correlated with low CD4 count. The prevalence of rifampicin resistance was 11%
Conclusion: In conclusion, when used as a routine screening test among people living with HIV, rapid screening using the Xpert MTB/RIF assay substantially increased case detection, supporting replacement of microscopy as the initial diagnostic tool. The assay also greatly decreased the time to diagnosis of tuberculosis and aids in early identification of Rifampicin-resistant tuberculosis.
References
- Jagielski T, Augustynowicz-Kopeć E, Zwolska Z. Epidemiologia gruźlicy w perspektywie świata, Europy i Polski [Epidemiology of tuberculosis: a global, European and Polish perspective]. Wiad Lek. 2010;63(3):230-46. Polish. PMID: 21125747.
- Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington (DC): National Academies Press (US); 2012. 2, Drug-Resistant TB in India.Available from: https://www.ncbi.nlm.nih.gov/books/NBK100386/
- Hanrahan CF, Selibas K, Deery CB, Dansey H, Clouse K, Bassett J, et al. Time to Treatment and Patient Outcomes among TB Suspects Screened by a Single Point-of-Care Xpert MTB/RIF at a Primary Care Clinic in Johannesburg, South Africa. PLoS One. 2013;8(6):e65421. Available from: http://dx.plos.org/10.1371/journal.pone.0065421
- Lawn SD, Brooks S V., Kranzer K, Nicol MP, Whitelaw A, Vogt M, et al. Screening for HIV-Associated Tuberculosis and Rifampicin Resistance before Antiretroviral Therapy Using the Xpert MTB/RIF Assay: A Prospective Study. PLoS Med. 2011;8(7):e1001067. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21818180
- Lawn SD, Kerkhoff AD, Vogt M, Ghebrekristos Y, Whitelaw A, Wood R. Characteristics and Early Outcomes of Patients With Xpert MTB/RIF-Negative Pulmonary Tuberculosis Diagnosed During Screening Before Antiretroviral Therapy. Clin Infect Dis. 2012;54(8): 1071–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22318975
- Balcells ME, García P, Chanqueo L, Bahamondes L, Lasso M, Gallardo AM, et al. Rapid molecular detection of pulmonary tuberculosis in HIVinfected patients in Santiago, Chile. Int J Tuberc Lung Dis. 2012;16(10):1349–53. Available from: http://openurl.ingenta.com/content/xref?genre=article&issn=10273719&volume=16 &issue=10&spage=1349
- Carriquiry G, Otero L, González-Lagos E, Zamudio C, Sánchez E, Nabeta P, et al. A diagnostic accuracy study of Xpert®MTB/RIF in HIV-positive patients with high clinical suspicion of pulmonary tuberculosis in Lima, Peru. PLoS One. 2012;7(9):e44626. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22970271
- R Dewan, S Anuradh, A Khanna, S Garg, S Singla et al. Role of cartridge-based nucleic acid amplification test (CBNAAT) for early diagnosis of pulmonary tuberculosis in HIV, Journal, Indian Academy of Clinical Medicine: 2015; 16(2): 114-7
- Isaakidis P, Das M, Kumar AMV, Peskett C, Khetarpal M, Bamne A, et al. Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India. PLoS One. 2014;9(10):1–10.
- Al-Darraji HAA, Razak HA, Ng KP, Altice FL, Kamarulzaman A. The Diagnostic Performance of a Single GeneXpert MTB/RIF Assay in an Intensified Tuberculosis Case Finding Survey among HIV-Infected Prisoners in Malaysia. PLoS One. 2013;8(9):1–10.