Clinical predictors of pulmonary TB among South African adults with HIV

TB0038

Mendelsohn, S.C., Fiore-Gartland, A., Awany, D., Mulenga, H., Mbandi, S.K., Tameris, M., Walzl, G., Naidoo, K., Churchyard, G., Scriba, T.J. and Hatherill, M., 2022. Clinical predictors of pulmonary tuberculosis among South African adults with HIV. EClinicalMedicine, 45.

CD4 count and antiretroviral initiation are associated with Mtb sensitization and TB disease.

Lower CD4 cell counts are associated with reduced IGRA positivity due to the loss or dysfunction of Mtb-specific T-cell memory responses in HIV.

Clinical prediction models are inadequate for detecting incipient and subclinical TB among people with HIV.

Subclinical TB cases missed by symptom screening may perpetuate Mtb transmission.

There is a need for more sensitive TB screening tools to find “missing” TB cases in high-incidence settings.

Novel active case-finding approaches are needed that do not rely on the presence of symptoms.

Simple clinical prediction models could be used as triage tools in resource-limited settings.

Chest radiography and computer-aided detection offer promise for affordable mass screening and have reasonable performance as a rule-out test for symptomatic individuals with presumptive TB.