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. 2014 Jun 25;1(1):ofu038.
doi: 10.1093/ofid/ofu038. eCollection 2014 Mar.

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

L Mupfumi  1 , B Makamure  1 , M Chirehwa  2 , T Sagonda  2 , S Zinyowera  3 , P Mason  1 , J Z Metcalfe  4 , R Mutetwa  2
Affiliations

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

L Mupfumi et al. Open Forum Infect Dis. .

Abstract

Introduction: 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.

Methods: 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.

Results: 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%).

Conclusions: Among HIV-infected initiating ART, centralized TB screening with Xpert did not reduce the rate of ART-associated TB and mortality, compared with fluorescence microscopy.

Keywords: ART-associated TB; GeneXpert MTB/RIF; HIV; screening; tuberculosis.

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Figures

Figure 1.
Figure 1.
Screening, enrollment, and follow-up of study patients. *All-cause mortality (mortality related to baseline TB diagnosis, ART-associated TB, or death from any cause during 3-month follow-up).
See this image and copyright information in PMC

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