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Report of a technical advisory meeting on research on AIDS and tuberculosis, Geneva, 2-4 August 1988.
[Unpublished] 1989. 21 p. (WHO/GPA/BMR/89.3)A technical advisory meeting on research on AIDS and tuberculosis was held to review and prioritize ongoing and planned research in the field, suggesting essential studies and study design. Studies in need of international collaboration, as well as subjects not covered by ongoing and planned research were considered, with attention given to recommending frameworks for development. The final major objective of the meeting was to determine key areas of TB programs requiring strengthening to facilitate such research, and to suggest developmental steps for improvement. The report provides opening background information of tuberculosis, AIDS, and the relationship between the 2, then launches into a discussion of urgently needed research. Epidemiological, diagnostic, clinical presentation, prevention, and treatment studies are called for under this section heading, each sub-section providing objectives, justification, and specific research questions. Design examples for selected research studies constitute an annex following the main body of text. When planning for action on suggested research, the report acknowledges the need for resources, organizational structures, detailed plans and timetables, and collaborative arrangements. 7 areas in which WHO could provide assistance are offered, followed by discussion of strengthening tuberculosis control capacity in WHO, and at the country and local levels. Selection of research sites is considered at the close of the text.
Evaluation of the World Health Organization clinical case definition of AIDS among tuberculosis patients in Kinshasa, Zaire [letter]
JOURNAL OF INFECTIOUS DISEASES. 1989 Nov; 160(5):902-3.Although the World Health Organization (WHO) clinical case definition for AIDS has been confirmed to have fair sensitivity, specificity, and positive prediction value in sub-Saharan Africa, its application among tuberculosis patients at the Makala Sanatorium in Kinshasa, Zaire, were evaluated in terms of this case definition by physicians who were not aware of their human immunodeficiency virus (HIV) serostatus. Screening for HIV-1 enzyme-liked immunosorbent assay (ELISA) and Western blot indicated that 85 (36%) of these patients were HIV-positive. In this population, the WHO clinical case definition had a sensitivity of 33%, a specificity of 86%, and a positive predictive value of 58% for HIV infection. When the case definition was modified to exclude chronic cough in tuberculosis patients as a minor criterion, the sensitivity decreased to 18% and the specificity and positive predictive value increased to 97% and 77%, respectively. A possible explanation for the low sensitivity of the WHO clinical case definition of HIV infection among tuberculosis patients is that tuberculosis may be an early manifestation of immunosuppression that precedes other signs and symptoms of AIDS. It is also possible that the chemotherapy administered to tuberculosis patients eliminates symptoms contained in the WHO case definition such as fever, cough, weight loss, and lymphadenopathy. These findings suggest that periodic serosurveys of tuberculosis patients may be more effective than use of the WHO clinical case definition in detecting HIV infection.
An assessment of the lower limit of specificity of the clinical definition of AIDS in Africa [letter]
AIDS. 1989 May; 3(5):323-4.Clinical data from 104 adult tuberculosis patients from Bangladesh, a country where AIDS has not been reported, were used to apply the original WHO clinical definition of AIDS, 2 variants, and a new definition that omits persistent cough, to eliminate false positive diagnosis of AIDS in TB patients. The patients had either acid-fast bacilli (61) or positive radiology. All had negative ELISA screens for HIV-1. WHO definitions 1, 2 and 3 gave false-positive rates of 66,80 and 47% respectively. Modification of the definitions to exclude persistent cough reduced this rate to 2%. Only 3 cases remained positive by at least 1 definition: 2 by lymphadenopathy and 1 by neurological signs (meningitis). This study confirms the substantial risk run by patients with unrecognized TB of being misdiagnosed as AIDS patients. For the health worker with little laboratory support, the clinical definition of AIDS in Africa would be a valuable tool provided that patients with chronic cough are tested for TB, and the modified definition applied.