%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Marcy, O.
%A Ung, V.
%A Goyet, S.
%A Borand, L.
%A Msellati, Philippe
%A Tejiokem, M.
%A Thi, N. L. N.
%A Nacro, B.
%A Cheng, S.
%A Eyangoh, S.
%A Pham, T. H.
%A Ouedraogo, A. S.
%A Tarantola, A.
%A Godreuil, S.
%A Blanche, S.
%A Delacourt, C.
%T Performance of Xpert MTB/RIF and alternative specimen collection methods for the diagnosis of tuberculosis in HIV-infected children
%D 2016
%L fdi:010066924
%G ENG
%J Clinical Infectious Diseases
%@ 1058-4838
%K tuberculosis ; children ; HIV infection ; diagnosis ; Xpert MTB/RIF
%K BURKINA FASO ; CAMBODGE ; CAMEROUN ; VIET NAM
%M ISI:000376381800017
%N 9
%P 1161-1168
%R 10.1093/cid/ciw036
%U https://www.documentation.ird.fr/hor/fdi:010066924
%> https://www.documentation.ird.fr/intranet/publi/2016/06/010066924.pdf
%V 62
%W Horizon (IRD)
%X Background. The diagnosis of tuberculosis in human immunodeficiency virus (HIV)-infected children is challenging. We assessed the performance of alternative specimen collection methods for tuberculosis diagnosis in HIV-infected children using Xpert MTB/RIF (Xpert). Methods. HIV-infected children aged <= 13 years with suspected intrathoracic tuberculosis were enrolled in 8 hospitals in Burkina Faso, Cambodia, Cameroon, and Vietnam. Gastric aspirates were taken for children aged < 10 years and expectorated sputum samples were taken for children aged >= 10 years (standard samples); nasopharyngeal aspirate and stool were taken for all children, and a string test was performed if the child was aged >= 4 years (alternative samples). All samples were tested with Xpert. The diagnostic accuracy of Xpert for culture-confirmed tuberculosis was analyzed in intention-to-diagnose and per-protocol approaches. Results. Of 281 children enrolled, 272 (96.8%) had >= 1 specimen tested with Xpert (intention-to-diagnose population), and 179 (63.5%) had all samples tested with Xpert (per-protocol population). Tuberculosis was culture-confirmed in 29/272 (10.7%) children. Intention-to-diagnose sensitivities of Xpert performed on all, standard, and alternative samples were 79.3% (95% confidence interval [CI], 60.3-92.0), 72.4% (95% CI, 52.8-87.3), and 75.9% (95% CI, 56.5-89.7), respectively. Specificities were >= 97.5%. Xpert combined on nasopharyngeal aspirate and stool had intention-to-diagnose and per-protocol sensitivities of 75.9% (95% CI, 56.5-89.7) and 75.0% (95% CI, 47.6-92.7), respectively. Conclusions. The combination of nasopharyngeal aspirate and stool sample is a promising alternative to methods usually recommended by national programs. Xpert performed on respiratory and stools samples enables rapid confirmation of tuberculosis diagnosis in HIV-infected children.
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