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.

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