The proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5mm or a 10mm cut-off: a systematic review

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dc.contributor.authorKerkhoff, Andrewen_ZA
dc.contributor.authorGupta, Ankuren_ZA
dc.contributor.authorSamandari, Tarazen_ZA
dc.contributor.authorLawn, Stephenen_ZA
dc.date.accessioned2015-10-28T06:50:53Z
dc.date.available2015-10-28T06:50:53Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND:A positive tuberculin skin test (TST) is often defined by skin induration of [greater than or equal to]10mm in people who are HIV-seronegative. However, to increase sensitivity for detection of Mycobacterium tuberculosis infection in the context of impaired immune function, a revised cut-off of [greater than or equal to]5mm is used for people living with HIV infection. The incremental proportion of patients who are included by this revised definition and the association between this proportion and CD4+ cell count are unknown. METHODS: The literature was systematically reviewed to determine the proportion of people living with HIV (PLWH) without evidence of active tuberculosis in low and middle-income countries who tested TST-positive using cut-offs of [greater than or equal to]5mm and [greater than or equal to]10mm of induration. The difference in the proportion testing TST-positive using the two cut-off sizes was calculated for all eligible studies and was stratified by geographical region and CD4+ cell count. RESULTS: A total of 32 studies identified meeting criteria were identified, providing data on 10,971 PLWH from sub-Saharan Africa, Asia and the Americas. The median proportion of PLWH testing TST-positive using a cut-off of [greater than or equal to]5mm was 26.8% (IQR, 19.8-46.1%; range, 2.5-81.0%). Using a cut-off of [greater than or equal to]10mm, the median proportion of PLWH testing TST-positive was 19.6% (IQR, 13.7-36.8%; range 0-52.1%). The median difference in the proportion of PLWH testing TST-positive using the two cut-offs was 6.0% (IQR, 3.4-10.1%; range, 0-37.6%). Among those with CD4+ cell counts of <200, 200-499 and [greater than or equal to]500 cells/muL, the proportion of positive tests defined by the [greater than or equal to]5mm cut-off that were between 5.0 and 9.9mm in diameter was similar (12.5%, 12.9% and 10.5%, respectively). CONCLUSIONS: There is a small incremental yield in the proportion of PLWH who test TST-positive when using an induration cut-off size of [greater than or equal to]5mm compared to [greater than or equal to]10mm. This proportion was similar across the range of CD4+ cell strata, supporting the current standardization of this cut-off at all levels of immunodeficiency.en_ZA
dc.identifier.apacitationKerkhoff, A., Gupta, A., Samandari, T., & Lawn, S. (2013). The proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5mm or a 10mm cut-off: a systematic review. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14428en_ZA
dc.identifier.chicagocitationKerkhoff, Andrew, Ankur Gupta, Taraz Samandari, and Stephen Lawn "The proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5mm or a 10mm cut-off: a systematic review." <i>BMC Infectious Diseases</i> (2013) http://hdl.handle.net/11427/14428en_ZA
dc.identifier.citationKerkhoff, A. D., Gupta, A., Samandari, T., & Lawn, S. D. (2013). The proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5 mm or a 10 mm cut-off: a systematic review. BMC infectious diseases, 13(1), 307.en_ZA
dc.identifier.ris TY - Journal Article AU - Kerkhoff, Andrew AU - Gupta, Ankur AU - Samandari, Taraz AU - Lawn, Stephen AB - BACKGROUND:A positive tuberculin skin test (TST) is often defined by skin induration of [greater than or equal to]10mm in people who are HIV-seronegative. However, to increase sensitivity for detection of Mycobacterium tuberculosis infection in the context of impaired immune function, a revised cut-off of [greater than or equal to]5mm is used for people living with HIV infection. The incremental proportion of patients who are included by this revised definition and the association between this proportion and CD4+ cell count are unknown. METHODS: The literature was systematically reviewed to determine the proportion of people living with HIV (PLWH) without evidence of active tuberculosis in low and middle-income countries who tested TST-positive using cut-offs of [greater than or equal to]5mm and [greater than or equal to]10mm of induration. The difference in the proportion testing TST-positive using the two cut-off sizes was calculated for all eligible studies and was stratified by geographical region and CD4+ cell count. RESULTS: A total of 32 studies identified meeting criteria were identified, providing data on 10,971 PLWH from sub-Saharan Africa, Asia and the Americas. The median proportion of PLWH testing TST-positive using a cut-off of [greater than or equal to]5mm was 26.8% (IQR, 19.8-46.1%; range, 2.5-81.0%). Using a cut-off of [greater than or equal to]10mm, the median proportion of PLWH testing TST-positive was 19.6% (IQR, 13.7-36.8%; range 0-52.1%). The median difference in the proportion of PLWH testing TST-positive using the two cut-offs was 6.0% (IQR, 3.4-10.1%; range, 0-37.6%). Among those with CD4+ cell counts of <200, 200-499 and [greater than or equal to]500 cells/muL, the proportion of positive tests defined by the [greater than or equal to]5mm cut-off that were between 5.0 and 9.9mm in diameter was similar (12.5%, 12.9% and 10.5%, respectively). CONCLUSIONS: There is a small incremental yield in the proportion of PLWH who test TST-positive when using an induration cut-off size of [greater than or equal to]5mm compared to [greater than or equal to]10mm. This proportion was similar across the range of CD4+ cell strata, supporting the current standardization of this cut-off at all levels of immunodeficiency. DA - 2013 DB - OpenUCT DO - 10.1186/1471-2334-13-307 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - The proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5mm or a 10mm cut-off: a systematic review TI - The proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5mm or a 10mm cut-off: a systematic review UR - http://hdl.handle.net/11427/14428 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14428
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-13-307
dc.identifier.vancouvercitationKerkhoff A, Gupta A, Samandari T, Lawn S. The proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5mm or a 10mm cut-off: a systematic review. BMC Infectious Diseases. 2013; http://hdl.handle.net/11427/14428.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2013 Kerkhoff et al.; licensee BioMed Central Ltden_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherTuberculin skin testen_ZA
dc.subject.otherTSTen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherCD4en_ZA
dc.titleThe proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5mm or a 10mm cut-off: a systematic reviewen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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