Point-of-care c-reactive protein testing to facilitate implementation of isoniazid preventive therapy for people living with HIV

Christina Yoon, J. Lucian Davis, Laurence Huang, Conrad Muzoora, Helen Byakwaga, Colin Scibetta, David Bangsberg, Payam Nahid, Fred C. Semitala, Peter W. Hunt, Jeffrey N. Martin, Adithya Cattamanchi

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Symptom-based tuberculosis screening identifies less than one-third of eligible HIV-infected patients as candidates for isoniazid preventive therapy (IPT). We evaluated whether testing for C-reactive protein (CRP) improves patient selection for IPT. Methods: We measured CRP levels (normal >10 mg/L) using a point-of-care (POC) assay on stored serum samples from HIVinfected Ugandan adults initiating antiretroviral therapy. We assessed diagnostic accuracy in reference to baseline tuberculosis status adjudicated by an expert committee and calculated net reclassification improvement to quantify the incremental discriminatory benefit of POC-CRP in determining IPT eligibility compared to the World Health Organization (WHO) symptom screen. Results: Of 201 patients (median CD4 cell count, 137 cells/mL; interquartile range, 83-206), 5 (2.5%) had tuberculosis. Compared to the WHO symptom screen, POC-CRP had similar sensitivity (100% vs. 80%, P = 0.30) but greater specificity (21% vs. 87%, P > 0.0001) for tuberculosis. If based on the WHO symptom screen, no patients with tuberculosis but only 42 of 196 patients without tuberculosis would have been considered IPT eligible. If POC-CRP were used instead, 1 patient with tuberculosis (reclassification of cases, 220%; P = 0.32) and 129 patients without tuberculosis (reclassification of noncases, +66%; P > 0.001) would have been reclassified as IPT eligible, a net reclassification improvement of 46% (P = 0.03). In addition, POC-CRP testing would have reduced the proportion of patients without active tuberculosis requiring confirmatory tuberculosis testing (87% vs. 21%, P > 0.0001). Conclusions: POC-CRP testing increased more than 4-fold the proportion of HIV-infected adults immediately identified as IPT eligible and decreased the proportion of patients requiring referral for further tuberculosis diagnostic testing. POC-CRP testing could substantially improve implementation of tuberculosis screening guidelines.

Original languageEnglish (US)
Pages (from-to)551-556
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Volume65
Issue number5
DOIs
StatePublished - Apr 15 2014
Externally publishedYes

Fingerprint

Point-of-Care Systems
Isoniazid
Tuberculosis
HIV
C-Reactive Protein
Proteins
Therapeutics
CD4 Lymphocyte Count
Patient Selection

Keywords

  • C-reactive protein
  • HIV
  • Isoniazid preventive therapy
  • TB screening
  • Tuberculosis
  • WHO symptom screen

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Point-of-care c-reactive protein testing to facilitate implementation of isoniazid preventive therapy for people living with HIV. / Yoon, Christina; Davis, J. Lucian; Huang, Laurence; Muzoora, Conrad; Byakwaga, Helen; Scibetta, Colin; Bangsberg, David; Nahid, Payam; Semitala, Fred C.; Hunt, Peter W.; Martin, Jeffrey N.; Cattamanchi, Adithya.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 65, No. 5, 15.04.2014, p. 551-556.

Research output: Contribution to journalArticle

Yoon, C, Davis, JL, Huang, L, Muzoora, C, Byakwaga, H, Scibetta, C, Bangsberg, D, Nahid, P, Semitala, FC, Hunt, PW, Martin, JN & Cattamanchi, A 2014, 'Point-of-care c-reactive protein testing to facilitate implementation of isoniazid preventive therapy for people living with HIV', Journal of Acquired Immune Deficiency Syndromes, vol. 65, no. 5, pp. 551-556. https://doi.org/10.1097/QAI.0000000000000085
Yoon, Christina ; Davis, J. Lucian ; Huang, Laurence ; Muzoora, Conrad ; Byakwaga, Helen ; Scibetta, Colin ; Bangsberg, David ; Nahid, Payam ; Semitala, Fred C. ; Hunt, Peter W. ; Martin, Jeffrey N. ; Cattamanchi, Adithya. / Point-of-care c-reactive protein testing to facilitate implementation of isoniazid preventive therapy for people living with HIV. In: Journal of Acquired Immune Deficiency Syndromes. 2014 ; Vol. 65, No. 5. pp. 551-556.
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abstract = "Background: Symptom-based tuberculosis screening identifies less than one-third of eligible HIV-infected patients as candidates for isoniazid preventive therapy (IPT). We evaluated whether testing for C-reactive protein (CRP) improves patient selection for IPT. Methods: We measured CRP levels (normal >10 mg/L) using a point-of-care (POC) assay on stored serum samples from HIVinfected Ugandan adults initiating antiretroviral therapy. We assessed diagnostic accuracy in reference to baseline tuberculosis status adjudicated by an expert committee and calculated net reclassification improvement to quantify the incremental discriminatory benefit of POC-CRP in determining IPT eligibility compared to the World Health Organization (WHO) symptom screen. Results: Of 201 patients (median CD4 cell count, 137 cells/mL; interquartile range, 83-206), 5 (2.5{\%}) had tuberculosis. Compared to the WHO symptom screen, POC-CRP had similar sensitivity (100{\%} vs. 80{\%}, P = 0.30) but greater specificity (21{\%} vs. 87{\%}, P > 0.0001) for tuberculosis. If based on the WHO symptom screen, no patients with tuberculosis but only 42 of 196 patients without tuberculosis would have been considered IPT eligible. If POC-CRP were used instead, 1 patient with tuberculosis (reclassification of cases, 220{\%}; P = 0.32) and 129 patients without tuberculosis (reclassification of noncases, +66{\%}; P > 0.001) would have been reclassified as IPT eligible, a net reclassification improvement of 46{\%} (P = 0.03). In addition, POC-CRP testing would have reduced the proportion of patients without active tuberculosis requiring confirmatory tuberculosis testing (87{\%} vs. 21{\%}, P > 0.0001). Conclusions: POC-CRP testing increased more than 4-fold the proportion of HIV-infected adults immediately identified as IPT eligible and decreased the proportion of patients requiring referral for further tuberculosis diagnostic testing. POC-CRP testing could substantially improve implementation of tuberculosis screening guidelines.",
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AU - Byakwaga, Helen

AU - Scibetta, Colin

AU - Bangsberg, David

AU - Nahid, Payam

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N2 - Background: Symptom-based tuberculosis screening identifies less than one-third of eligible HIV-infected patients as candidates for isoniazid preventive therapy (IPT). We evaluated whether testing for C-reactive protein (CRP) improves patient selection for IPT. Methods: We measured CRP levels (normal >10 mg/L) using a point-of-care (POC) assay on stored serum samples from HIVinfected Ugandan adults initiating antiretroviral therapy. We assessed diagnostic accuracy in reference to baseline tuberculosis status adjudicated by an expert committee and calculated net reclassification improvement to quantify the incremental discriminatory benefit of POC-CRP in determining IPT eligibility compared to the World Health Organization (WHO) symptom screen. Results: Of 201 patients (median CD4 cell count, 137 cells/mL; interquartile range, 83-206), 5 (2.5%) had tuberculosis. Compared to the WHO symptom screen, POC-CRP had similar sensitivity (100% vs. 80%, P = 0.30) but greater specificity (21% vs. 87%, P > 0.0001) for tuberculosis. If based on the WHO symptom screen, no patients with tuberculosis but only 42 of 196 patients without tuberculosis would have been considered IPT eligible. If POC-CRP were used instead, 1 patient with tuberculosis (reclassification of cases, 220%; P = 0.32) and 129 patients without tuberculosis (reclassification of noncases, +66%; P > 0.001) would have been reclassified as IPT eligible, a net reclassification improvement of 46% (P = 0.03). In addition, POC-CRP testing would have reduced the proportion of patients without active tuberculosis requiring confirmatory tuberculosis testing (87% vs. 21%, P > 0.0001). Conclusions: POC-CRP testing increased more than 4-fold the proportion of HIV-infected adults immediately identified as IPT eligible and decreased the proportion of patients requiring referral for further tuberculosis diagnostic testing. POC-CRP testing could substantially improve implementation of tuberculosis screening guidelines.

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