A new, clinically-based algorithm for the diagnosis of HIV in African tuberculosis patients: cross-sectional analysis from Mzuzu, Malawi

We aimed to create an improved, clinically-based algorithm for the diagnosi s of HIV in tuberculosis (TB) patients. Cross-sectional analysis was perfor med on data from adult TB patients consecutively diagnosed at a Malawian di strict level hospital. Of 225 patients, 187 with valid HIV results were inc luded in the study. Sixty-seven per cent were HIV seropositive. Urban addre ss, history of skin rash and sexually transmitted diseases (STDs) and, on e xamination, oral candidiasis and lymphadenopathy, were associated with I-W co-infection. Using these clinical characteristics, a case definition for H IV was constructed. The Mzuzu clinical case definition was highly sensitive (86%). The area under the receiver operating characteristic (ROC) curve wa s 0.81, significantly larger than existing World Health Organization (WHO) clinical case definitions. The Mzuzu definition is proposed for further eva luation in settings where HIV serological testing is not readily available.