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."
Contact: Office of Communications, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention; T): 404-639-8895; E): kstanton@cdc.gov .
The Lancet