Point-of-care C-reactive protein testing to facilitate implementation of isoniazid preventive therapy for people living with HIV.

摘要: Author(s): Yoon, Christina; Davis, J Lucian; Huang, Laurence; Muzoora, Conrad; Byakwaga, Helen; Scibetta, Colin; Bangsberg, David R; Nahid, Payam; Semitala, Fred C; Hunt, Peter W; Martin, Jeffrey N; Cattamanchi, Adithya | Abstract: BackgroundSymptom-based tuberculosis screening identifies less than one-third of eligible HIV-infected patients as candidates for isoniazid preventive therapy (IPT). We evaluated whether testing C-reactive protein (CRP) improves patient selection IPT.MethodsWe measured CRP levels (normal l10 mg/L) using a point-of-care (POC) assay on stored serum samples from Ugandan adults initiating antiretroviral therapy. assessed diagnostic accuracy in reference to baseline status adjudicated by an expert committee and calculated net reclassification improvement quantify the incremental discriminatory benefit POC-CRP determining IPT eligibility compared World Health Organization (WHO) symptom screen.ResultsOf 201 (median CD4 cell count, 137 cells/μL; interquartile range, 83-206), 5 (2.5%) had tuberculosis. Compared WHO screen, similar sensitivity (100% vs. 80%, P = 0.30) but greater specificity (21% 87%, l 0.0001) If based no with only 42 196 without would have been considered eligible. were used instead, 1 (reclassification cases, -20%; 0.32) 129 noncases, +66%; 0.001) reclassified eligible, 46% (P 0.03). In addition, reduced proportion active requiring confirmatory (87% 21%, 0.0001).ConclusionsPOC-CRP increased more 4-fold immediately identified decreased referral further testing. could substantially improve implementation guidelines.