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Study suggests chest radiography unnecessary to identify tuberculosis among HIV patients in resource-poor settings (pp 1516, 1551)
November 05, 2003Embargoed 0001 h (London time) 7 November 2003.
Authors of a research letter in this week's issue of THE LANCET provide evidence that counters UNAIDS/WHO guidelines with respect to preventive tuberculosis treatment for people with HIV-1 infection. Chest radiography-considered important by UNAIDS/WHO in screening out people with tuberculosis before preventive antibiotic treatment can be initiated-was not found to be necessary.
HIV-1 infection is a major risk factor for tuberculosis. Preventive antibiotic programmes are being initiated in some less-developed settings; however this approach can only be effective if patients with active tuberculosis are excluded, to avoid the emergence of antibiotic resistance. UNAIDS/WHO recommend that, in addition to history and physical examination, chest radiography be done on each patient being assessed for preventive antibiotic therapy. However, cost and accessibility of chest radiography are important issues to be balanced against its potential effectiveness in less-developed countries.
Barudi Mosimaneotsile from the Centres for Disease Control and Prevention, USA, and colleagues from Botswana's Ministry of Health prospectively assessed 935 HIV-infected outpatients seeking antibiotic preventive therapy. Of 935 patients, 692 (74%) had no signs or symptoms of tuberculosis and were thereforeassigned to receive chest radiography to help identify further cases of tuberculosis. Of these 692 people, 123 (18%) were lost during the chest radiograph process, and one (0.2%) of the remaining 563 was diagnosed with tuberculosis on the basis of the chest radiograph.
Barudi Mosimaneotsile comments: "A screening chest radiograph should not be required routinely for asymptomatic people taking isoniazid as preventive treatment in settings able to screen for signs and symptoms of tuberculosis."
Lancet
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