Impact of Xpert MTB/RIF on Antiretroviral Therapy-Associated Tuberculosis and Mortality: A Pragmatic Randomized Controlled Trial

Open Forum Infectious Diseases
L MupfumiR Mutetwa

Abstract

GeneXpert® MTB/RIF (Xpert) is now widely distributed in high human immunodeficiency virus (HIV)/tuberculosis (TB)-burden countries. Yet, whether the test improves patient-important outcomes within HIV treatment programs in limited resource settings is unknown. To investigate whether use of Xpert for TB screening prior to initiation of antiretroviral treatment (ART) improves patient-important outcomes, in a pragmatic randomized controlled trial we assigned 424 patients to Xpert or fluorescence sputum smear microscopy (FM) at ART initiation. The primary endpoint was a composite of 3-month mortality and ART-associated TB. There was no difference in overall TB diagnosis at ART initiation (20% [n = 43] Xpert vs 21% [n = 45] FM; P = .80), with most patients in both groups treated empirically. There was no difference in time to TB treatment initiation {5 days (interquartile range [IQR], 3-13) vs 8 days [IQR, 3-23; P = .26]} or loss to follow-up (32 [15%] vs 38 [18%]; P = 0.38). Although a nonsignificant reduction in mortality occurred in the Xpert group (11 [6%] vs 17 [10%]; 95% CI, -9% to 2%; P = .19), there was no difference in the composite outcome (9% [n = 17] Xpert vs 12% [n = 21] FM; difference -3%; 95% CI, -9% to 4%). Among HIV...Continue Reading

References

May 15, 1980·The New England Journal of Medicine·S G Pauker, J P Kassirer
Aug 15, 2006·JAMA : the Journal of the American Medical Association·Jeffrey S A StringerMoses Sinkala
Aug 26, 2006·The Lancet Infectious Diseases·Karen R SteingartMadhukar Pai
Jul 26, 2008·The Lancet Infectious Diseases·Graeme MeintjesUNKNOWN International Network for the Study of HIV-associated IRIS
Nov 5, 2008·Annals of Internal Medicine·Eric LimDouglas G Altman
Jan 22, 2010·The New England Journal of Medicine·Peter J Neumann, Sean R Tunis
May 27, 2010·Lancet·Nellie Bristol
Jul 14, 2010·Tropical Medicine & International Health : TM & IH·Matthew P Fox, Sydney Rosen
Aug 26, 2010·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Ingrid V BassettKenneth A Freedberg
Mar 15, 2011·The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·D J Bratton, A J Nunn
Oct 19, 2011·The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·A TrébucqH L Rieder
Nov 29, 2011·The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·Jerome Amir Singh, Anant Bhan
Feb 10, 2012·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Stephen D LawnRobin Wood
Jun 26, 2012·Clinical Chemistry·Patrick M M BossuytKarel G M Moons
Nov 28, 2012·The European Respiratory Journal·Karin WeyerMario Raviglione
Mar 28, 2013·The Lancet Infectious Diseases·Stephen D LawnAlimuddin Zumla
Jun 22, 2013·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Jason R AndrewsRochelle P Walensky
Jul 23, 2013·PLoS Medicine·Jill LuotoPaul G Shekelle
Aug 2, 2013·The European Respiratory Journal·Claudia M DenkingerMadhukar Pai
Aug 21, 2013·The Lancet Infectious Diseases·Molebogeng Xheedha Rangaka, Robert John Wilkinson
Jan 23, 2014·The Cochrane Database of Systematic Reviews·Karen R SteingartNandini Dendukuri

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Citations

Oct 20, 2015·Expert Opinion on Pharmacotherapy·Emanuele PontaliGiovanni Battista Migliori
Jul 26, 2015·The Lancet. Respiratory Medicine·Annelies Van Rie
Mar 13, 2015·Current Opinion in Pulmonary Medicine·Ruth McNerney, Alimuddin Zumla
Mar 27, 2015·International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases·Ruth McNerneyAlimuddin Zumla
Sep 18, 2016·Transactions of the Royal Society of Tropical Medicine and Hygiene·Andrew F AuldStephen D Lawn
May 26, 2016·PloS One·Carole D MitnickUNKNOWN RESIST-TB (Research Excellence to Stop TB Resistance) and GDI (Global Drug Resistant TB Initiative)
Jul 31, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Lucky G NgwiraDavid W Dowdy
Oct 31, 2019·Proceedings of the National Academy of Sciences of the United States of America·Rachel Cassidy, Charles F Manski
Jun 8, 2019·The Cochrane Database of Systematic Reviews·David J HorneKaren R Steingart
Feb 9, 2017·BMC Infectious Diseases·Jason M BachaAnna M Mandalakas
Jan 7, 2017·Current Opinion in HIV and AIDS·Lesley ScottChristopher M Gilpin
Sep 20, 2019·Southern African Journal of HIV Medicine·Charlotte SchutzAndrew D Kerkhoff
Aug 9, 2017·African Journal of Laboratory Medicine·Ishani PathmanathanHeather Alexander
Feb 6, 2017·Microbiology Spectrum·Wendy Susan StevensKeertan Dheda
Jun 8, 2021·The Cochrane Database of Systematic Reviews·Frederick HarakaAmanda Ross
Aug 21, 2021·The Cochrane Database of Systematic Reviews·Ruvandhi R NathavitharanaMaunank Shah
Dec 23, 2021·The New England Journal of Medicine·Adithya CattamanchiAchilles Katamba

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Methods Mentioned

BETA
fluorescence microscopy
nucleic acid amplification
Fluorescence
fluorescence smear microscopy

Software Mentioned

Xpert
XTEND
Stata
R

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