Diagnosing active and latent tuberculosis among Iranian HIV-infected patients.

OBJECTIVE: To screen for Tuberculosis (TB) in human immunodeficiency virus (HIV) people in an effort to improve early TB diagnosis and reduce TB transmission. METHODS: A prospective study was conducted on adult HIV people from 2008 to 2011. Three samples of sputum, cell blood count, tuberculin skin test (TST) and chest X-ray were obtained from all patients. The characteristics of HIV patients with TB and HIV patients without TB were compared to each other. RESULTS: Of the 154 HIV patients included, 58 (38%) had tuberculosis with a mean CD4 cell count of 68 cells/mm3 . Active TB was found in 56 (47%) patients with a history of intravenous drug use. Cough (OR = 3.1, 95% CI 1.2-7.79), positive TST (OR = 8.15, 95% CI 3.28-20.25) and an abnormal chest X-ray (OR = 5.1, 95% CI 1.84-14.2) were the predicting factors for detecting active TB among HIV patients. The sensitivity and specificity of a combination of any symptoms with chest X-ray, smear, TST or all of these were 96.5% and 86.5%, respectively. CD4 cell count <100 (OR = 2.67; 95% CI 1.23-5.78) and smoking (OR = 13.4; 95% CI 3.04-59.4) remained independently associated with TB in a multivariate analysis. CONCLUSION: There was a high prevalence of TB within the HIV population. Screening for TB among these patients can be carried out at every clinic or health facility using a combination of symptoms, TST, chest X-ray and smear sample.

Performance of QuantiFERON-TB Gold test compared to tuberculin skin test in detecting latent tuberculosis infection in HIV- positive individuals in Iran.

BACKGROUND: There is limited data about the performance of QuantiFERON-TB Gold (QFT-G) test in detecting latent tuberculosis infection (LTBI) in our region. We intended to determine the performance of QFT-G compared to conventional tuberculin skin test (TST) in detecting LTBI in HIV-positive individuals in Iran. METHODS: This study was conducted in a HIV clinic in Tehran, Iran in April 2007. A total of 50 consecutive HIV-positive patients, not currently affected with active tuberculosis (TB), were recruited; 43 (86%) were male. The mean age was 38 ± 7.2 years (21-53). All had history of Bacillus Calmette Guerin (BCG) vaccination. A TST with purified protein derivative (PPD) and whole-blood interferon-gamma release assay (IGRA) in reaction to ESAT-6 and CFP-10 antigens was performed and measured by enzyme-linked immuno-sorbent assay (ELISA). The agreement between TST and QFT-G results were analyzed using Kappa test. RESULTS: A total of 36 (72%) patients had negative and 14 (28%) revealed positive TST. For QFT-G, 20 (40%) tested positive, 19 (38%) tested negative, and the results in 11 cases (22%) were indeterminate. A total of 14 (28%) patients had a CD4 count of <200. Of the 14, TST + group, 12 had QFT-G +, only one case TST+/QFT-G-, and QFT-G was indeterminate in one TST positive case. Of the 36 patients with negative TST tests, 8 (22%) had positive GFT-G and 10 (28%) yielded indeterminate results. There was no association between a positive TST and receiving highly active anti-retroviral therapy (HAART) or absolute CD4 counts. Similarly, the association between QFT-G results and receiving HAART or CD4 counts was not significant (P = 0.06). Although TST results were not significantly different in patients with CD4 < 200 vs. CD4 >200 (P = 0.295), association between QFT-G results and CD4 cutoff of 200 reached statistical significance (P = 0.027). Agreement Kappa coefficient between TST and QFT-G was 0.54 (Kappa = 0.54, 95% CI = 38.4-69.6,P < 0.001). CONCLUSION: Detecting LTBI in HIV-positive individuals showed moderate agreement between QFT-G and LTBI in our study. Interestingly, our findings revealed that nontuberculous mycobacteria and prior BCG vaccination have minimal influence on TST results in HIV patients in Iran.

Frequency and associated factors of proteinuria in Iranian HIV-positive patients.

BACKGROUND: Screening HIV-positive patients for proteinuria would result in early recognition of HIV-associated nephropathy (HIVAN). This would allow diagnosis and treatment of HIVAN at an early stage and hence prevent further disease progression. This study was undertaken to determine the frequency of proteinuria and its associated factors in Iranian HIV-positive patients. METHODS: In this study, 171 HIV-positive patients were screened for proteinuria. Proteinuria was defined as > or =1+ protein on the urine dipstick. A questionnaire was used to collect patient sociodemographic and clinical data. Hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV), serum albumin, and creatinine were tested in all patients. CD4 counts were obtained by flow cytometry. RESULTS: Out of 171 HIV-positive patients, 21 (12.3%) had proteinuria. There were no significant differences between patients with and without proteinuria with regard to age, sex, risk behaviors for HIV acquisition, stage of infection, concurrent antiretroviral therapy, systolic and diastolic blood pressure, serum albumin and creatinine, glomerular filtration rate (GFR), and presence of anti-HCV or HBsAg. Patients with proteinuria had a lower CD4 count and creatinine clearance than those without proteinuria. CONCLUSION: Proteinuria was relatively high in Iranian HIV-positive patients. The group at higher risk was that of patients with lower CD4 counts and creatinine clearance.