Efficacy of Xpert MTB/RIF Assay in the Diagnosis of Smear Negative HIV Seropositive Pulmonary Tuberculosis Patients
Keywords:
Xpert MTB/RIF, Pulmonary Tuberculosis, Smear Negative, HIV
Abstract
Background: Tuberculosis (TB) is the most common presenting illness and leading cause of death among people living with HIV(PLHIV). Diagnosis of TB among PLHIV is challenging as false negative results are common with direct microscopy (DM) and culture takes long time. WHO (2013) recommended Xpert MTB/RIF assay as an initial test for diagnosis of TB in PLHIV. Methods: The present study was conducted on 142 HIV seropositive patients who were clinically suspected to have TB. The sputum specimens obtained from these patients were divided into two parts; one was processed by DM and the other was used for Xpert MTB/RIF assay. Result: Of the 142 HIV seropositive patients, 90(63.3%) were in the age group of 15-40 years and majority 91(64.08%) were males. Out of 142 sputum specimens collected from these patients, only 5(3.52%) were positive by DM and 31(21.83%) by Xpert MTB/RIF assay. Statistically the difference between the two was significant (p value <0.005). Xpert MTB/RIF assay showed rifampicin resistant in 2(6.45%) specimen. Of the 137 smear negative specimens, Xpert MTB/RIF assay gave positive result in 27 (19.70%). Thus, the sensitivity, specificity, PPV, NPV of the Xpert MTB/RIF assay in comparison to DM was 80% (95%CI=37.6- 96.4), 80.29% (95%CI=72.8-86.1), 12.90% (95%CI=4.21-30.76), 99.09%(95%CI=94.3-99.9) respectively. Conclusion: Xpert MTB/RIF assay was found to be a sensitive, specific and rapid method for diagnosis of TB and rifampicin resistance in smear negative PLHIV. It’s availability as an initial diagnostic test in PLHIV could significantly reduce the delay in initiation of treatment and prevent the transmission of the disease.References
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3. Xpert MTB/RIF for people living with HIV. Available at:http://www.who. int/tb/challenges/hiv/Xpert_TBHIV_Information_Note_final.pdf.Accessed 21 April 2017.
4. Dewan R, Anuradha S, Khanna A, Garg S, Singla S, Ish P, et al. Role of cartridge-based nucleic acid amplification test (CBNAAT) for early diagnosis of pulmonary tuberculosis in HIV. JIACM. 2015; 16(2):114-7.
5. TB India 2017, Annual status report, Central TB division, chapter 2 https:// tbcindia.gov.in/writereaddata/TB%20India%202017.pdf
6. National Guidelines for HIV Testing. Available at:http://www.naco.gov .in/sites/default/files/National_Guidelines_for_HIV_Testing_21Apr2016.pdf. Accessed 22 March 2017.
7. Bhadke BB, Rathod RK, Mulay SD, Deshmukh DG, Mahajan PD. Efficacy of Gene Xpert in diagnosing MTB/RIF resistance in HIV seropositive and seronegative patients: a study in comparison. International Journal of Medical Microbiology and Tropical Diseases . 2017; 3(2):50-6.
8. Kokoma LN, Mukesi M, Moyo SR. Effectiveness of Gene Xpert technology in the diagnosis of smear-negative pulmonary mycobacterium tuberculosis in HIV positive patients in Namibia. Open J Med Microbiol. 2016; 6(3):133-41.
9. WHO (2011) Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of and rifampicin resistance: Xpert MTB/RIF System.
10. Ioannidis P, Papaventsis D, Karabela S, Nikolaou S, Panagi M, Raftopoulou E, et al. Cepheid Gene Xpert MTB/RIF assay for Mycobacterium detection and rifampin resistance identification in patients with substantial clinical indications of and smear-negative microscopy results. J Clin Microbiol. 2017; 49:3068-70.
11. Ngyuyen T, Dorothee H, Do Dang T, Tran T, Nguyen TH, Ho Dang T et al. Evaluation of Gene Xpert MTB/RIF for Diagnosis of Tuberculosis Meningitis. J Clin Microbiol. 2014; 52(1):226-33.
12. Bansal D, Avashia S, Karothiya M. A study of Gene Xpert in screening of sputum in HIV positive patients presenting to tertiary care centre. National J Community Med. 2016; 7(8):657-60.
Published
2019-02-18
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