Comparative performance of the laboratory assays used by a Diagnostic Laboratory Hub for opportunistic infections in people living with HIV.
Objectives: We evaluated the comparative performance of different assays used in a Diagnostic Laboratory Hub that linked 13 HIV healthcare facilities for the diagnosis of tuberculosis (TB), histoplasmosis, and cryptococcosis, and describing its functions in Guatemala compared with other National Ref...
| Publicado en: | AIDS (02699370) Vol. 34; no. 11; pp. 1625 - 1633 |
|---|---|
| Autores principales: | , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Sep2020
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=145641817&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 145641817 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02699370 6FD jtl: AIDS (02699370) issn: 02699370 maglogo: N pubinfo: dt: Sep2020 vid: 34 iid: 11 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 145641817 145641817 NLM32694415 145641817 10.1097/QAD.0000000000002631 NLM32694415 145641817 ppf: 1625 ppct: 8 formats: tig: atl: Comparative performance of the laboratory assays used by a Diagnostic Laboratory Hub for opportunistic infections in people living with HIV. aug: au: Medina, Narda Alastruey-Izquierdo, Ana Mercado, Danicela Bonilla, Oscar Pérez, Juan C. Aguirre, Luis Samayoa, Blanca Arathoon, Eduardo Denning, David W. Rodriguez-Tudela, Juan Luis Pérez, Juan Carlos affil: Asociacion de Salud Integral, Guatemala, Guatemala sug: subj: Tuberculosis Diagnosis HIV Infections Complications Immunologic Tests Methods Laboratories Standards AIDS-Related Opportunistic Infections Diagnosis Histoplasmosis Diagnosis Cryptococcosis Diagnosis Aged Young Adult Adolescence Cryptococcus Immunology Antigens, Fungal Blood Middle Age AIDS-Related Opportunistic Infections Epidemiology Human Adult Sensitivity and Specificity Validation Studies Comparative Studies Evaluation Research Multicenter Studies Ferrans and Powers Quality of Life Index Scales Aged: 65+ years Adolescent: 13-18 years Middle Aged: 45-64 years Adult: 19-44 years ab: Objectives: We evaluated the comparative performance of different assays used in a Diagnostic Laboratory Hub that linked 13 HIV healthcare facilities for the diagnosis of tuberculosis (TB), histoplasmosis, and cryptococcosis, and describing its functions in Guatemala compared with other National Reference Laboratories.Methods: The following diagnostic techniques were analyzed in 24 months (2017-2018) in a cohort of patients with HIV: smear microscopy, mycobacterial and fungal cultures, isolator blood culture, PCR assays, and antigen detection tests.Results: A total of 4245 patients were included, 716 (16.2%) had an opportunistic infection: 249 (34.7%) TB, 40 (5.6%) nontuberculous mycobacteria, 227 (31.7%) histoplasmosis, 138 (19.3%) cryptococcosis, and 62 (8.6%) had multiple opportunistic infections. Two hundred sixty-three [92.6%; 95% confidence interval (CI), 89-95.1] of TB cases were diagnosed by PCR. Urine antigen assay detected 94% (95% CI, 89-96) of the disseminated histoplasmosis cases. A lateral flow assay to detect cryptococcal antigen diagnosed 97% (95% CI, 93.3-98.7%) of the cryptococcal cases. In 85 patients (51.5%) with a cerobrospinal fluid sample, cryptococcal meningitis was diagnosed in 55 (64.7%), of which 18 (32.7%) were only detected by cryptococcal antigen.Conclusion: Validated commercial antigen tests, as used in this program, should be the new gold standard for histoplasmosis and cryptococcosis diagnosis. In their absence, 35% of disseminated histoplasmosis and 32.7% of cryptococcal meningitis cases would have been missed. Patients with multiple opportunistic infections were frequently diagnosed and strategies should be designed to screen patients irrespective of their clinical presentation. In low resource settings, Diagnostic Laboratory Hubs can deliver quality diagnostics services in record time at affordable prices. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|