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Comparison of Löwenstein–Jensen and BACTEC MGIT 960 culture for Mycobacterium tuberculosis in people living with HIV
Author(s) -
Hongler J,
Musaazi J,
Ledergerber B,
Eberhard N,
SekaggyaWiltshire C,
Keller PM,
Fehr J,
Castelnuovo B
Publication year - 2018
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12635
Subject(s) - medicine , liquid culture , tuberculosis , mycobacterium tuberculosis , sputum , culture conversion , hazard ratio , human immunodeficiency virus (hiv) , sputum culture , odds ratio , confidence interval , gastroenterology , immunology , pathology , biology , botany
Objectives The aim of the study was to clarify how HIV infection affects tuberculosis liquid and solid culture results in a resource‐limited setting. Methods We used baseline data from the Study on Outcomes Related to Tuberculosis and HIV Drug Concentrations in Uganda ( SOUTH ), which included 268 HIV /tuberculosis ( TB )‐coinfected individuals. Culture results from Löwenstein–Jensen ( LJ ) solid culture and mycobacteria growth indicator tube ( MGIT ) liquid culture systems and culture‐based correlates for bacillary density from the sputum of HIV / TB ‐coinfected individuals at baseline were analysed. Results Of 268 participants, 243 had a CD 4 cell count available and were included in this analysis; 72.2% of cultures showed growth on solid culture and 82.2% in liquid culture systems ( P < 0.015). A higher CD 4 cell count was predictive of LJ positivity [adjusted odds ratio ( OR ) 1.14; 95% confidence interval ( CI ) 1.03–1.25 per 50 cells/ μ L increase; P = 0.008]. The same, but insignificant trend was observed for MGIT positivity (adjusted OR 1.09; 95% CI 0.99–1.211 per 50 cells/ μ L increase; P = 0.094). A higher CD 4 cell count was associated with a higher LJ colony‐forming unit grade (adjusted OR 1.14; 95% CI 1.05–1.25 per 50 cells/ μ L increase; P = 0.011) and a shorter time to MGIT positivity [adjusted hazard ratio ( HR ) 1.08; 95% CI 1.04–1.12 per 50 cells/ μ L increase; P < 0.001]. Conclusions In a resource‐limited setting, the MGIT liquid culture system outperformed LJ solid culture in terms of culture yield and dependence on CD 4 cell counts in HIV / TB ‐coinfected individuals. We therefore suggest considering an adaptation of diagnostic algorithms: when resources allow only one culture method to be performed, we recommend that MGIT liquid culture should be used exclusively in HIV ‐positive individuals as a first‐line culture method, to reduce costs and make TB culture results accessible to more patients in resource‐limited settings.