1641. Diagnostic Value of Urine Mycobacterial Culture for Tuberculosis in People Living with HIV — Cambodia, Thailand, and Vietnam, 2006–2008
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: One-quarter of all deaths of people living with HIV (PLHIV) are due to tuberculosis (TB).  Extrapulmonary TB, common in PLHIV, is associated with negative sputum test result, delayed diagnosis and increased mortality, especially among severely immunocompromised persons. We evaluated urine testing for TB in PLHIV, because urine is the easiest specimen to obtain and does not generate infectious aerosols.

Methods:   We examined the diagnostic yield of urine culture (UC) from a cross-sectional study of PLHIV in Cambodia, Thailand, and Vietnam during 2006–2008.  Sputum, blood, urine, stool, and lymph node specimens (for those with a lymph node >1cm) were obtained for mycobacterial culture from all patients. TB was confirmed if at least one specimen culture was positive for Mycobacterium tuberculosiscomplex.  Logistic regression was performed to assess associations with positive UC among all patients with confirmed TB.

Results: Of 1,898 PLHIV, 253 (13%) had confirmed TB; of these, 138 (55%) had a positive extrapulmonary culture result.  Of the 138, 46 (33%) had a positive UC result; of these, 30 (65%) had a CD4+ T-lymphocyte (CD4) count of <50 cells/µL.   Among those with confirmed TB, PLHIV with a positive UC result were more likely to have a CD4 count of <50 cells/µL (odds ratio [OR]: 11.2; confidence interval [CI]: 3.7–33.6) and a fever (OR: 11.2; CI: 2.6–47.7).  Of the 8 patients with only extrapulmonary TB and CD4 <50 cell/µl, 3 (38%) were diagnosed exclusively by UC.

Conclusion: Mycobacterial UC identified a substantial proportion of HIV-infected TB patients with CD4 <50 cells/µL whose TB would not otherwise have been diagnosed.  UC may increase confirmation of TB disease in PLHIV with severe immune compromise.

Negar Alami, MD1,2, Charles Heilig, PhD2, Joseph Cavanaugh, MD2, Kimberly Mccarthy, MM2, Jay Varma, MD3 and Kevin Cain, MD2, (1)Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, (2)Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, (3)Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand

Disclosures:

N. Alami, None

C. Heilig, None

J. Cavanaugh, None

K. Mccarthy, None

J. Varma, None

K. Cain, None

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