The Diagnostic Performance of Chest-X-Ray and Erythrocyte Sedimentation Rate in Comparison with GeneXpert^® for Tuberculosis Case Notification Among Patients Living with Human Immunodeficiency Virus in a Resource-Limited Setting: A Cross-Sectional Study

Figures & data

Table 1 Demographic and Some Clinical Data of Presumptive TB-HIV Co-Infection Patients Among Presumptive TB Cases, ATRH, 2019

Characteristics			N (%)
Sex	Male		199 (51.8)
	Female		185 (48.2)
Age category (years)	=<18 years		45 (11.7)
	18–60 years		324 (84.4)
Clinical characteristics	Cough		372 (97.1)
	Fever		298 (77,8)
	Weight loss		257 (67.1)
	Previous TB treatment last 12 months		84 (21.9)
	INH prophylaxis (ever)		161 (42.0)
	CPT prophylaxis (ever)		302 (78.9)
	WHO clinical stages	III	53 (13.8)
		T1	119 (30.9)
		T3	130 (33.9)
Laboratory	Hematocrit	Normal	224 (59.4)
		Anemia	153 (40.6)
	CD4 count in last 6 months	<200 cell/mL	104 (38.2)
		≥200 cell/mL	168 (61.8)
	HIV viral load in the last 6 months	<1000 copy/mL	39 (48.1)
		≥1000 copy/mL	42 (51.9)
	ESR	<50 mm/hour	123 (37.0)
		50–99 mm/hour	104 (31.3)
		≥100 mhouL/r	105 (31.6)

Abbreviations: ATRH, Asella teaching and referral hospital; CPT, cotrimoxazole preventive therapy; ESR, erythrocyte sedimentation rate; HIV, human immunodeficiency virus; INH, isoniazid preventive therapy; TB, tuberculosis; WHO, World Health Organization.

Table 2 Hematologic, Immunologic and HIV Viral Load Outline of Patients GeneXpert Positive and Negative, ATRH, 2019

Hematological and Viral Parameters	GeneXpert MTB-Positive, N=79 Mean ± SD	GeneXpert MTB Negative, N=305 Mean ± SD	p-value
WBC* x 10^3	7.2 ± 4.4	8.8 ±2.7	0.45
Hematocrit (%)	32.6 ± 7.7	36.8 ± 6.5	0.00
ESR (mm/hour)	73.0 ± 38.8	67.4 ± 41.8	0.25
CD4 cell count (cell/mL) in the last 6 months	272 ± 240.2	367.2 ± 289.8	0.005
HIV viral load (copy/mL) x10^3 in the last 6 months	89.3 ± 20.0	27.1 ± 6.9	0.04

Abbreviations: ATRH, Asella teaching and referral hospital; ESR, erythrocyte sedimentation rate; HIV, human immunodeficiency virus; MTB, Mycobacterium tuberculosis; SD, standard deviation; WBC, white blood cell.

Figure 1 Receiver operating characteristic (ROC) of ESR and GeneXpert showing the performance of ESR in the diagnosis of TB among PLHIV. Cut-off points of ESR: ≥50 mL/hour has a sensitivity of 32.2% and specificity of 39.1%.

Table 3 Sensitivity, Specificity, PPV, NPV of ESR Taking GeneXpert as Gold Standard, ATRH, 2019

ESR and CXR Results		GeneXpert Result		GeneXpert as a Reference
		Positive	Negative	Sensitivity	Specificity	PPV	NPV
ESR (mm/hour)	<50	26	189	32.2% (21.4–45.3)	38.1% (22.8–49.7)	12.6% (4.5–25.3)	68.4% (55.3–84.7)
	≥50	53	116
	<100	39	137	49.4% (35.3–62.8)	55.1% (33.4–67.3)	22.1% (10.2–34.5)	83.0% (70.1–93.2)
	≥100	40	168
CXR compatible with TB	Yes	54	69	67.9% (43.2–79.5)	77.3% (55.3–88.7)	43.8% (31.6–59.5)	90.2% (82.3–97.6)
	No	25	236

Abbreviations: ATRH, Asella teaching and referral hospital; CXR, chest-x-ray; ESR, erythrocyte sedimentation rate; NPV, negative predictive value; PPV, positive predictive value.

Table 4 Factors Associated with Compatible Chest-X-Ray Finding with TB on Univariate and Multivariate Logistic Regression, ATRH, 2019

Some Clinical and Laboratory Variables		Chest-X-Ray Finding Compatible with TB
		COR	p-value	AOR	p-value
Duration of cough (in weeks)	<2	1.24	0.003	1.07	0.34
	≥2	1		1
Contact with chronic cougher	Yes	1.53	0.13	0.834	0.96
	No	1
TB treatment in last 12 months	Yes	1.26	0.022	1.85*	0.017
	No	1		1
INH prophylaxis over last 12 months	Yes	1		1
	No	27.00	0.00	14.30*	0.012
Hematocrit level (%)	<34	2.324	0.001	1.62	0.20
	≥34	1		1
BMI (kg/m^2)	<18.5	1.31	0.004	0.001	0.97
	≥18.5	1		1
ESR level (mm/hour)	<50	1		1
	≥50	1.402	0.071	1.58	0.11
WHO clinical stage of HIV/AIDS	I & II	1.44	<0.001	0.856	0.36
	III & IV	1		1

Note: *The value is significant.

Abbreviations: ATRH, Asella teaching and referral hospital; BMI, body mass index; INH, isoniazid prophylactic therapy; ESR, erythrocyte sedimentation rate; HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; COR, crude odd ratio; AOR, adjusted odd ratio; TB, tuberculosis; WHO, World Health Organization.

Table 5 Factors Associated with Increased ESR Level on Univariate and Multivariate Logistic Regression, ATRH, 2019

Factors		Increased ESR Level (≥50 mm/hour)
		COR	95% CI	p-value	AOR	95% CI	p-value
Hematocrit level (%)	<34	2.79	1.76–4.42	0.00	4.86*	1.44–16.33	0.01
	≥34	1			1
BMI (kg/m^2)	<18.5	1.20	0.97–1.50	0.043	1.39	0.44–4.36	0.57
	≥18.5	1			1
WHO clinical stage of HIV/AIDS	I & II	1			1
	III &IV	1.24	0.98–1.56	0.047	1.04	0.28–3.83	0.96
CD4 count (cell/mL)	<200	1.13	0.96–1.33	0.013	1.05	0.65–1.15	0.41
	≥200	1			1
Type of TB	Pulmonary	1			1
	Disseminated	1.41	1.21–1.64	<0.001	3.37*	1.64–6.94	0.001

Note: *The value is significant.

Abbreviations: ATRH, Asella teaching and referral hospital; BMI, body mass index; COR, crude odd ratio; AOR, adjusted odd ratio; ESR, erythrocyte sedimentation rate; HIV/AIDS, human immunodeficiency virus/acquired immunodeficiency syndrome; TB, tuberculosis; WHO, World Health Organization.