Efetividade do GeneXpert® no diagnóstico da tuberculose em pessoas que vivem com HIV/aids
DOI:
https://doi.org/10.11606/s1518-8787.2021055003125Palabras clave:
Tuberculose Pulmonar, diagnóstico, Técnicas de Diagnóstico Molecular, Infecções por HIV, Infecções Oportunistas Relacionadas com a AIDSResumen
OBJETIVO Identificar e sintetizar o conhecimento científico produzido a respeito da efetividade do teste GeneXpert no diagnóstico da tuberculose (TB) pulmonar em pessoas vivendo com HIV/aids. MÉTODOS Revisão integrativa da literatura, cuja busca foi feita nas plataformas Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex e Lilacs, em dezembro de 2019. Os estudos levantados passaram por duas etapas de seleção: leitura dos títulos e resumos por dois revisores de forma independente, utilizando a plataforma Rayyan e leitura integral dos mesmos. Foram incluídos 19 estudos primários em inglês, português e espanhol que respondiam à pergunta norteadora do estudo: Qual é a efetividade do teste GeneXpert no diagnóstico da TB pulmonar em pessoas que vivem com HIV/aids? RESULTADOS A utilização do GeneXpert aumentou substancialmente a detecção de casos de TB entre a população coinfectada com HIV, com sensibilidade que variou de 68% a 100%, sendo superior à baciloscopia. A especificidade variou de 91,7% a 100%; o valor preditivo positivo, de 79,2% a 96,1%; e o valor preditivo negativo, de 84,6% a 99,3%, valores considerados semelhantes à baciloscopia pela maioria dos estudos. O teste também foi comparado com as diferentes formas de realização da cultura e outros testes moleculares, sendo considerado inferior apenas ao Xpert Ultra. CONCLUSÃO É possível afirmar que locais com alta incidência de HIV se beneficiariam com a implantação do teste GeneXpert, uma vez que sua efetividade no diagnóstico da TB pulmonar nessa população é expressiva quando comparada à baciloscopia, teste que foi por muito tempo amplamente utilizado para a detecção dos casos.
Referencias
World Health Organization. Global tuberculosis control: WHO report 2011. Geneva (CH): WHO; 2011.
World Health Organization. Global tuberculosis report 2016. Geneva (CH): WHO; 2016.
Lawn SD, Wood R. Tuberculosis in antiretroviral treatment services in resource-limited settings: addressing the challenges of screening and diagnosis. J Infect Dis. 2011;204 Suppl 4:S1159-67. https://doi.org/;10.1093/infdis/jir411
World Health Organization. Roadmap for rolling out Xpert MTB/RIF for rapid diagnosis of TB and MDR-TB. Geneva (CH): WHO; 2010.
Dewan R, Anuradha S, Khanna A, Garg S, Singla S, Agarwal S, et al. Role of cartridge-based nucleic acid amplification test (CBNAAT) for early diagnosis of pulmonary tuberculosis in HIV. JIACM. 2015;16(2):114-7.
Scott LE, McCarthy K, Gous N, Nduna M, Van Rie A, Sanne I, et al. Comparison of Xpert MTB/RIF with other nucleic acid technologies for diagnosing pulmonary tuberculosis in a high HIV prevalence setting: a prospective study. PLoS Med. 2011;8(7):e1001061. https://doi.org/10.1371/journal.pmed.1001061
World Health Organization. Global tuberculosis report 2014. Geneva (CH): WHO; 2014.
Palomino JC. Molecular detection, identification and drug resistance detection in Mycobacterium tuberculosis. FEMS Immunol Med Microbiol. 2009;56(2):103-11. https://doi.org/10.1111/j.1574-695X.2009.00555.x
Bassett IV, Wang B, Chetty S, Giddy J, Losina E, Mazibuko M, et al. Intensive tuberculosis screening for HIV-infected patients starting antiretroviral therapy in Durban, South Africa. Clin Infect Dis. 2010;51(7):823-9. https://doi.org/10.1086/656282
Boehme CC, Nabeta P, Hillemann D, Nicol MP, Shenai S, Krapp F, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010;363(11):1005-15. https://doi.org/10.1056/NEJMoa0907847
Iram S, Zeenat A, Hussain S, Yusuf NW, Aslam M. Rapid diagnosis of tuberculosis using Xpert MTB/RIF assay: report from a developing country. Pak J Med Sci. 2015;31(1):105-10. https://doi.org/10.12669/pjms.311.6970
Harries AD, Zachariah R, Corbett EL, Lawn SD, Santos-Filho ET, Chimzizi R, et al. The HIV-associated tuberculosis epidemic–when will we act? Lancet. 2010;375(9729):1906-19. https://doi.org/10.1016/S0140-6736(10)60409-6
World Health Organization. Tuberculosis diagnostics: automated DNA test: WHO endorsement and recommendations. Geneva (CH): WHO; 2010.
Helb D, Jones M, Story E, Boehme C, Wallace E, Ho K, et al. Rapid detection of Mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology. J Clin Microbiol. 2020;48(1):229-37. https://doi.org/10.1128/JCM.01463-09
World Health Organization. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system: policy statement. Geneva (CH): WHO; 2011.
World Health Organization. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update. Geneva (CH): WHO; 2013.
Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53. https://doi.org/10.1111/j.1365-2648.2005.03621.x
The Joanna Briggs Institute. Critical appraisal tools for use in JBI systematic reviews. Adelaide (AU): JBI; 2017 [citado 22 jan 2020]. Disponível em: https://joannabriggs.org/ebp/critical_appraisal_tools
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan – a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. https://doi.org/10.1186/s13643-016-0384-4
Moher D, Liberati A, Tetzlaff J, Altman DG; The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;21;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097
Ursi ES. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura [dissertação]. Ribeirão Preto, SP: Escola de Enfermagem da Universidade de São Paulo; 2005.
Dagnra AY, Mlaga KD, Adjoh K, Kadanga E, Disse K, Adekambi T. Prevalence of multidrug-resistant tuberculosis cases among HIV-positive and HIV-negative patients eligible for retreatment regimen in Togo using GeneXpert MTB/RIF. New Microbes New Infect. 2015;8):24-7. https://doi.org/10.1016/j.nmni.2015.09.001
Rachow A, Zumla A, Heinrich N, Rojas-Ponce G, Mtafya B, Reither K. Rapid and accurate detection of mycobacterium tuberculosis in sputum samples by Cepheid Xpert MTB/RIF assay: a clinical validation study. PLoS One. 2011;6(6):e20458. https://doi.org/10.1371/journal.pone.0020458
Sumangala V, Venkatesha DT, Chennaveerappa PK, Gayathree L. Role of GeneXpert® MTB/RIF assay for early diagnosis of pulmonar tuberculosis in people living with HIV. J Int Med Dent. 2017;4(2):56-60. https://doi.org/10.18320/JIMD/201704.0256
Lawn SD, Brooks SV, Kranzer K, Nicol MP, Whitelaw A, Vogt M, et al. Screening for HIV-associated tuberculosis and rifampicin resistance before antiretroviral therapy using the Xpert MTB/RIF assay: a prospective study. PLoS Med. 2011;8(7):e1001067. https://doi.org/10.1371/journal.pmed.1001067
Balcha TT, Sturegård E, Winqvist N, Skogmar S, Reepalu A, Jemal ZH, et al. Intensified tuberculosis case-finding in HIV-positive adults managed at Ethiopian health centers: diagnostic yield of Xpert MTB/RIF compared with smear microscopy and liquid culture. PLoS One. 2014;22;9(1):e85478. https://doi.org/10.1371/journal.pone.0085478
Griesel R, Stewart A, Plas H, Sikhondze W, Rangaka MX, Nicol MP, et al. Optimizing tuberculosis diagnosis in human immunodeficiency virus-infected inpatients meeting the criteria of seriously ill in the World Health Organization algorithm. Clin Infect Dis. 2018;66(9):1419-26. https://doi.org/10.1093/cid/cix988
Akanbi MO, Achenbach C, Taiwo B, Idoko J, Ani A, Yetunde Isa Y, et al. Evaluation of gene xpert for routine diagnosis of HIV-associated tuberculosis in Nigeria: a prospective cohort study. BMC Pulm Med. 2017;17:87. https://doi.org/10.1186/s12890-017-0430-6
O'Grady J, Bates M, Chilukutu L, Mzyece J, Cheelo J, Chilufya M, et al. Evaluation of the Xpert MTB/RIF assay at a tertiary care referral hospital in a setting where tuberculosis and HIV infection are highly endemic. Clin Infect Dis. 2012;55(9):1171-8. https://doi.org/10.1093/cid/cis631
Theron G, Peter J, Zyl-Smit R, Mishra H, Streicher E, Murray S, et al. Evaluation of the Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in a high HIV prevalence setting. Am J Respir Crit Care Med. 2011;184(1):132-40. https://doi.org/10.1164/rccm.201101-0056OC
Mbu ET, Sauter F, Zoufaly A, Bronsvoort BMC, Morgan K, Noeske J, et al. Tuberculosis in people newly diagnosed with HIV at a large HIV care and treatment center in Northwest Cameroon: burden, comparative screening and diagnostic yields, and patient outcomes. PLoS One. 2018;13(6):e0199634. https://doi.org/10.1371/journal.pone.0199634
Ssengooba W, Nakiyingi L, Armstrong DT, Cobelens FG, Alland D, Manabe YC, et al. Clinical utility of a novel molecular assay in various combination strategies with existing methods for diagnosis of HIV-related tuberculosis in Uganda. PLoS One. 2014;9(9):e107595. https://doi.org/10.1371/journal.pone.0107595
Cavanaugh JS, Modi S, Musau S, McCarthy K, Alexander H, Burmen B, et al. Comparative yield of different diagnostic tests for tuberculosis among people living with HIV in Western Kenya. PLoS One. 2016;11(3):e0152364. https://doi.org/10.1371/journal.pone.0152364
Mollel EW, Chilongola JO, Mpagama SG; Kibiki GS. Evaluation of XpertMTB/RIF performance for diagnosis of tuberculosis among HIV positive patients in northern Tanzania. Tanzan J Health Res. 2017;19(1):1-9. https://doi.org/10.4314/thrb.v19i1.1
Dorman SE, Schumacher SG, Alland D, Nabeta P, Armstrong DT, King B, et al. Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study. Lancet Infect Dis. 2018;18(1):76-84. https://doi.org/10.1016/S1473-3099(17)30691-6
Auld SC, Moore BK, Killam WP, Eng B, Nong K, Pevzner EC, et al. Rollout of Xpert® MTB/RIF in Northwest Cambodia for the diagnosis of tuberculosis among PLHA. Public Health Action. 2014;4(4):216-21. https://doi.org/10.5588/pha.14.0082
Balcells ME, García P, Chanqueo L, Bahamondes L, Lasso M, Gallardo AM, et al. Rapid molecular detection of pulmonary tuberculosis in HIV-infected patients in Santiago, Chile. Int J Tuberc Lung Dis. 2012;16(10):1349-53. https://doi.org/10.5588/ijtld.12.0156
Lawn SD, Kerkhoff AD, Vogt M, Ghebrekristos Y, Whitelaw A, Wood R. Characteristics and early outcomes of patients with Xpert MTB/RIF-negative pulmonary tuberculosis diagnosed during screening before antiretroviral therapy. Clin Infect Dis. 2012;54(8):1071-9. https://doi.org/10.1093/cid/cir1039
Mederos Cuervo LM, Martinez Romero MR, Sardiñas Aragón M, García Léon G, Chilemo TS, Díaz Rodrígues R. Importancia diagnóstica del GeneXpert Mtb – Rif¨ en pacientes infectados por el Virus de Inmunodeficiencia Humana (VIH). AVFT Arch Venez Farmacol Ter. 2018;37(4):355-9.
Mboma SM, Houben RMGJ, Glynn JR, Sichali L, Drobniewski F, Mpunga J, et al. Control of (multi)drug resistance and tuberculosis incidence over 23 years in the context of a well-supported tuberculosis programme in rural Malawi. PLoS One. 2013;8(3):e58192. https://doi.org/10.1371/journal.pone.0058192
Getahun H, Harrington M, O’Brien R, Nunn P. Diagnosis of smear negative pulmonary tuberculosis in people with HIV infection of AIDS in resource-constrained settings: informing urgent policy changes. Lancet. 2007;369(9578):2042-9. https://doi.org/10.1016/S0140-6736(07)60284-0
Steingart KR, Schiller I, Horne DJ, Pai M, Boehme CC, Dendukuri N. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev 2014;(1):CD009593. https://doi.org/10.1002/14651858.CD009593
Deepak A, Neerja J, Renu B, Shilpa A. Rapid detection of Mycobacterium tuberculosis in sputum samples by Cepheid Xpert Assay: a clinical study. J Clin Diagn Res. 2015;9(5):DC03-5. https://doi.org/10.7860/JCDR/2015/11352.5935
Rawat J, Biswas D, Sindhwani G, Kesharwani V, Masih V, Chauhan BS. Diagnostic defaulters: an overlooked aspect in the Indian Revised National Tuberculosis Control Program. J Infect Dev Ctries. 2012;6(1):20-2. https://doi.org/10.3855/jidc.1895
Ardizzoni E, Farjado E, Saranchuk P, Casenghi M, Page AN, Varaine F, et al. Implementing the Xpert® MTB/RIF diagnostic test for tuberculosis and rifampicin resistance: outcomes and lessons learned in 18 countries. Plos One. 2015;10(12):e0144656. https://doi.org/10.1371/journal.pone.0144656
Chakravorty S, Simmons AM, Rowneki M, Parmar H, Cao Y, Ryan J. The New Xpert MTB/RIF Ultra: improving detection of Mycobacterium tuberculosis and resistance to rifampin in an assay suitable for point-of-care testing. mBio. 2017;8(4):e00812-17. https://doi.org/10.1128/mBio.00812-17
Churchyard GJ, Stevens WS, Mametja LD, McCarthy KM, Chihota V, Nicol MP, et al. Xpert MTB/RIF versus sputum microscopy as the initial diagnostic test for tuberculosis: a cluster-randomised trial embedded in South African roll-out of Xpert MTB/RIF. Lancet Glob Health. 2015;3(8):e450-7. https://doi.org/10.1016/S2214-109X(15)00100-X
Vittor AY, Garland JM, Gilman RH. Molecular diagnosis of TB in the HIV positive population. Ann Glob Health. 2015;80(6):476-85. https://doi.org/10.1016/j.aogh.2015.01.001
Moreira WB, editor. Leitura crítica de artigos científicos. São Paulo: Sociedade Brasileira de Oncologia Clínica; 2016. Capítulo 5, Artigos sobre testes diagnósticos; p. 83-90.
Descargas
Publicado
Número
Sección
Licencia
Derechos de autor 2021 Mariana Gaspar Botelho Funari de Faria, Rubia Laine de Paula Andrade, Ana Julia Gonçalves Camillo, Karina Fonseca de Souza Leite, Nanci Michele Saita, Valdes Roberto Bollela, Carlos Eduardo Menezes de Rezende, Aline Aparecida Monroe
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
