help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Published ahead of print on September 14, 2006, doi:10.1164/rccm.200606-759OC

Am. J. Respir. Crit. Care Med., Volume 175, Number 1, January 2007, 87-93

A more recent version of this article appeared on January 1, 2007
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200606-759OCv1
175/1/87    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wood, R.
Right arrow Articles by Bekker, L.-G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wood, R.
Right arrow Articles by Bekker, L.-G.

Submitted on June 8, 2006
Accepted on September 14, 2006

Undiagnosed Tuberculosis in a Community with High HIV-prevalence: Implications for TB Control

Robin Wood1, Keren Middelkoop1, Landon Myer2, Alison D Grant3, Andrew Whitelaw4, Stephen D Lawn5, Gilla Kaplan6, Robin Huebner7, James McIntyre8, and Linda-Gail Bekker9*

1 University of Cape Town, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa, 2 Infectious Diseases Epidemiology Unit, Faculty of Health Sciences, University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa; Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA, 3 Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom, 4 National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa, 5 University of Cape Town, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa; Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom, 6 Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, Newark, New Jersey, USA, 7 Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, DHHS, Bethesda, Maryland, USA, 8 The Perinatal Health Research Unit, University of Witwatersrand, Johannesburg, Gauteng, South Africa, 9 University of Cape Town, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa; The Department of Medicine, University of Cape Town, Cape Town, South Africa

* To whom correspondence should be addressed. E-mail: linda-gail.bekker{at}hiv-research.org.za.

Background Although failure of tuberculosis (TB) control in sub-Saharan Africa is attributed to the HIV epidemic, it is unclear why the directly observed therapy short course (DOTS) strategy is insufficient in this setting. We conducted a cross-sectional survey of pulmonary TB (PTB) and HIV infection in a community of 13,000 with high HIV prevalence and high TB notification rate and a well-functioning DOTS TB control program. Methods Active case-finding for PTB was performed in 762 adults using sputum microscopy and M.tuberculosis culture; testing for HIV and a symptom and risk factor questionnaire. Survey findings were correlated with notification data extracted from the TB treatment register. Findings. Of those surveyed, 174 (23%) tested HIV-positive, 11 (7 HIV-positive) were receiving TB therapy, 6 (5 HIV-positive) had previously undiagnosed smear-positive PTB and 6 (4 HIV-positive) had smear-negative/culture-positive PTB. Symptoms were not a useful screen for PTB. Among HIV-positive and negative individuals prevalence of notified smear-positive PTB was 1,563/100,000 and 352/100,000, undiagnosed smear-positive PTB prevalence was 2,837/100,000 and 175/100,000 and case finding proportions were 37% and 67%, respectively. Estimated duration of infectiousness was similar for HIV-positive and HIV-negative individuals. However, 87% of total person-years of undiagnosed smear-positive TB in the community were among HIV-infected individuals. Interpretation PTB was identified in 9% of HIV-infected individuals with 5% being previously undiagnosed. Lack of symptoms suggestive of PTB may contribute to low case finding rates. DOTS strategies based on passive case finding should be supplemented by active case finding targeting HIV-infected individuals.
Key words: Pulmonary tuberculosis, incidence and prevalence, HIV-infection, Case finding, African community.




This article has been cited by other articles:


Home page
 Am. J. Respir. Crit. Care Med.Home page
B. J. Marais
Does Finding M. Tuberculosis in Sputum Always Equal Tuberculosis Disease?
Am. J. Respir. Crit. Care Med., January 15, 2010; 181(2): 195 - 196.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
R. N. van Zyl Smit, M. Pai, W. W. Yew, C. C. Leung, A. Zumla, E. D. Bateman, and K. Dheda
Global lung health: the colliding epidemics of tuberculosis, tobacco smoking, HIV and COPD
Eur. Respir. J., January 1, 2010; 35(1): 27 - 33.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
R. R. Reves and W. J. Burman
Sorting Out Icebergs, Mirages, and Clinical Tuberculosis during Active Case Finding
Am. J. Respir. Crit. Care Med., December 15, 2009; 180(12): 1167 - 1169.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
J. J. Lewis, S. Charalambous, J. H. Day, K. L. Fielding, A. D. Grant, R. J. Hayes, E. L. Corbett, and G. J. Churchyard
HIV Infection Does Not Affect Active Case Finding of Tuberculosis in South African Gold Miners
Am. J. Respir. Crit. Care Med., December 15, 2009; 180(12): 1271 - 1278.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
D. V. Havlir, H. Getahun, I. Sanne, and P. Nunn
Opportunities and Challenges for HIV Care in Overlapping HIV and TB Epidemics
JAMA, July 23, 2008; 300(4): 423 - 430.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
T. Cohen, C. Colijn, A. Wright, M. Zignol, A. Pym, and M. Murray
Challenges in Estimating the Total Burden of Drug-resistant Tuberculosis
Am. J. Respir. Crit. Care Med., June 15, 2008; 177(12): 1302 - 1306.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
S. D. Lawn, R. J. Wilkinson, M. C. I. Lipman, and R. Wood
Immune Reconstitution and "Unmasking" of Tuberculosis during Antiretroviral Therapy
Am. J. Respir. Crit. Care Med., April 1, 2008; 177(7): 680 - 685.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
K. DeRiemer, L. M. Kawamura, P. C. Hopewell, and C. L. Daley
Quantitative Impact of Human Immunodeficiency Virus Infection on Tuberculosis Dynamics
Am. J. Respir. Crit. Care Med., November 1, 2007; 176(9): 936 - 944.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
W. W. Yew and C. C. Leung
Update in Tuberculosis 2006
Am. J. Respir. Crit. Care Med., March 15, 2007; 175(6): 541 - 546.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
B. Williams and D. Maher
Tuberculosis Fueled by HIV: Putting Out the Flames
Am. J. Respir. Crit. Care Med., January 1, 2007; 175(1): 6 - 8.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2006 American Thoracic Society 		  Registrer for the conference