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 language | English (US) |
|---|---|
| Pages (from-to) | 551-556 |
| Number of pages | 6 |
| Journal | Journal of Acquired Immune Deficiency Syndromes |
| Volume | 65 |
| Issue number | 5 |
| DOIs | |
| State | Published - Apr 15 2014 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
T1 - Point-of-care c-reactive protein testing to facilitate implementation of isoniazid preventive therapy for people living with HIV
AU - Yoon, Christina
AU - Davis, J. Lucian
AU - Huang, Laurence
AU - Muzoora, Conrad
AU - Byakwaga, Helen
AU - Scibetta, Colin
AU - Bangsberg, David
AU - Nahid, Payam
AU - Semitala, Fred C.
AU - Hunt, Peter W.
AU - Martin, Jeffrey N.
AU - Cattamanchi, Adithya
PY - 2014/4/15
Y1 - 2014/4/15
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.
AB - 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.
KW - C-reactive protein
KW - HIV
KW - Isoniazid preventive therapy
KW - TB screening
KW - Tuberculosis
KW - WHO symptom screen
UR - http://www.scopus.com/inward/record.url?scp=84898017045&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84898017045&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000000085
DO - 10.1097/QAI.0000000000000085
M3 - Article
C2 - 24346636
AN - SCOPUS:84898017045
VL - 65
SP - 551
EP - 556
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
SN - 1525-4135
IS - 5
ER -