Baseline Xpert MTB/RIF ct values predict sputum conversion during the intensive phase of anti-TB treatment in HIV infected patients in Kampala, Uganda: a retrospective study

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dc.contributor.authorNamugenyi, Juliet
dc.contributor.authorMusaazi, Joseph
dc.contributor.authorKatamba, Achilles
dc.contributor.authorKalyango, Joan
dc.contributor.authorSendaula, Emmanuel
dc.contributor.authorKambugu, Andrew
dc.contributor.authorFehr, Jan
dc.contributor.authorCastelnouvo, Barbara
dc.contributor.authorManabe, Yukari C.
dc.contributor.authorSsengooba, Willy
dc.contributor.authorSekaggya-Wiltshire, Christine
dc.date.accessioned2022-02-02T15:41:03Z
dc.date.available2022-02-02T15:41:03Z
dc.date.issued2021
dc.description.abstractIn resource-limited settings, sputum smear conversion is used to document treatment response. Many People living with HIV (PLHIV) are smear-negative at baseline. The Xpert MTB/RIF test can indirectly measure bacterial load through cycle threshold (ct) values. This study aimed to determine if baseline Xpert MTB/RIF could predict time to culture negativity in PLHIV with newly diagnosed TB. Methods: A subset of 138 PLHIV from the ‘SOUTH’ study on outcomes related to TB and antiretroviral drug concentrations were included. Bacterial load was estimated by Mycobacterium Growth Indicator Tubes (MGIT) culture time-to-positivity (TTP) and Lowenstein Jensen (LJ) colony counts. Changes in TTP and colony counts were analyzed with Poisson Generalised Estimating Equations (GEE) and multilevel ordered logistic regression models, respectively, while time to culture negativity analysed with Cox proportional hazard models. ROC curves were used to explore the accuracy of the ct value in predicting culture negativity. Results: A total of 81 patients (58.7%) were males, median age 34 (IQR 29 ̶ 40) years, median CD4 cell count of 180 (IQR 68 ̶345) cells/μL and 77.5% were ART naive. The median baseline ct value was 25.1 (IQR 21.0 ̶ 30.1). A unit Increase in the ct value was associated with a 5% (IRR = 1.05 95% CI 1.04 ̶ 1.06) and 3% (IRR = 1.03 95% CI 1.03 ̶ 1.04) increase in TTP at week 2 and 4 respectively. With LJ culture, a patient’s colony grade was reduced by 0.86 times (0R = 0.86 95% CI 0.74 ̶ 0.97) at week 2 and 0.84 times (OR = 0.84 95% CI 0.79 ̶ 0.95 P = 0.002) at week 4 for every unit increase in the baseline ct value. There was a 3% higher likelihood of earlier conversion to negativity for every unit increase in the ct value. A ct cut point ≥28 best predicted culture negativity at week 4 with a sensitivity of 91. 7% & specificity 53.7% while a cut point ≥23 best predicted culture negativity at week 8. Conclusion: Baseline Xpert MTB/RIF ct values predict sputum conversion in PLHIV on anti-TB treatment. Surrogate biomarkers for sputum conversion in PLHIV are still a research priority.en_US
dc.identifier.citationNamugenyi, J., Musaazi, J., Katamba, A., Kalyango, J., Sendaula, E., Kambugu, A., ... & Sekaggya-Wiltshire, C. (2021). Baseline Xpert MTB/RIF ct values predict sputum conversion during the intensive phase of anti-TB treatment in HIV infected patients in Kampala, Uganda: a retrospective study. BMC Infectious Diseases, 21(1), 1-9. https://doi.org/10.1186/s12879-021-06220-6en_US
dc.identifier.urihttps://doi.org/10.1186/s12879-021-06220-6
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/1768
dc.language.isoenen_US
dc.publisherBMC Infectious Diseasesen_US
dc.subjectMycobacterium tuberculosisen_US
dc.subjectHIVen_US
dc.subjectXpert MTB/RIFen_US
dc.subjectBaseline ct valuesen_US
dc.subjectTime to positivityen_US
dc.subjectColony counten_US
dc.titleBaseline Xpert MTB/RIF ct values predict sputum conversion during the intensive phase of anti-TB treatment in HIV infected patients in Kampala, Uganda: a retrospective studyen_US
dc.typeArticleen_US
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