Value of chest X-ray in TB diagnosis in HIV-infected children living in resource-limited countries: the ANRS 12229-PAANTHER 01 study

O B J E C T I V E: To evaluate inter-reader agreement and diagnostic accuracy of chest radiography (CXR) in the diagnosis of tuberculosis (TB) in children with human immunodeficiency virus (HIV) infection. D E S I G N: HIV-infected children with clinically suspected TB were enrolled in a prospective study conducted in Burkina Faso, Cambodia, Cameroon and Viet Nam from April 2010 to December 2014. Three readers—a local radiologist, a paediatric pulmonologist and a paediatric radiologist—independently reviewed the CXRs. Inter-reader agreement was then assessed using the j coefficient. Diagnostic accuracy of CXR was assessed in culture-confirmed cases and controls. R E S U L T S: A total of 403 children (median age 7.3 years, interquartile range 3.5–9.7; 49.6% males) were enrolled. Inter-reader agreement was as follows: between local radiologist and paediatric pulmonologist, j ¼ 0.36 (95%CI 0.27–0.45); local radiologist and paediatric radiologist, j ¼ 0.16 (95%CI 0.08–0.24); and paediatric pulmonologist and paediatric radiologist, j ¼ 0.30 (95%CI 0.21–0.40). Among 51 cases and 151 controls, after a consensus, CXR had a sensitivity of 71.4% (95%CI 58.8–84.1) and a specificity of 50.0% (95%CI 41.9–58.1). Alveolar opacities and enlarged lymph nodes on CXR had limited specificity for TB (64.7% and 70.2%, respectively). Miliary and/or nodular opacities patterns on CXR were more specific to TB (specificity 94.3%). C O N C L U S I O N: CXR showed poor-to-fair inter-reader agreement and limited diagnostic accuracy for TB in HIV-infected children, likely due to comorbidities. Radiological criteria for this specific population require further investigation.