Research Article

The Utility of C-reactive Protein Levels and Tb Lam Test as Diagnostic Tools for Tuberculosis among HIV Art Clients, attending Fort Portal Regional -Referral Hospital-Uganda

Authors: Kato Jacob, Simon Peter Rugero, Mathias Tumwebaze, Mabuga William.

DOI: 10.33425/2639-9458.1211

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Abstract

Background: Diagnosing tuberculosis (TB) in HIV-positive patients on Antiretroviral Therapy (ART) remains challenging, especially in resource-limited settings. C-reactive protein (CRP) levels and TB LAM tests have been suggested as potential diagnostic tools. This study aimed to assess the utility of CRP tests and TB LAM in diagnosing TB among HIV patients on ART at Fort Portal Regional Referral Hospital.

Methods: We conducted analytical cross-sectional study that, extracted quantitative data from HIV clients on ART at Fort Portal Regional Referral Hospital. This aimed to establish CRP levels and TB LAM test as diagnostic tools and the associated factors. Study respondents were purposively selected from ART clinic.

Results: The study covered 401 participants with a median age 43.7 ± 12 years. Majority 60.1% were females and 40% males. The median (IQR) CRP levels were 5 (1.37-5) mg/L. This study revealed a CRP threshold of 0.325 mg/L with a moderate TB LAM sensitivity at 62.3% with low GENEXPERT sensitivity at 37.7%. However, the specificity for detecting TB for both TB LAM and Gene Expert was high at 96.4% and 94.6% for TB LAM and GENE EXPERT respectively. The positive predictive values were 71.7% and 100% for TBLAM and Gene Expert respectively, while Negative predictive value for TBLAM was 94.6% and for Gene expert 91.3%. This established that advanced HIV clinical stage (≥ stage 2, aOR: 15.77, p = 0.013), lower education levels (aOR: 0.21, p = 0.021), and shorter duration of HIV infection (aOR: 0.17, p = 0.028) were associated with TB LAM positivity.

Conclusions: Use of CRP in triaging and TB LAM tests as diagnostic tool for TB in HIV-positive patients on ART remain a good strategy in TB diagnosis. However, with TB LAM moderate sensitivity and high specificity may limit its use as a standalone diagnostic tool. Use of Gene Expert with high positive predictive performance improves the diagnostic outcome particularly in resource-limited settings like Fort Portal Regional Referral Hospital.

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