An assessment of nucleic acid amplification testing for active mycobacterial infection


Comparison of AFB microscopy and NAAT, using culture as a reference standard in HIV-positive and HIV-negative patients



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Comparison of AFB microscopy and NAAT, using culture as a reference standard in HIV-positive and HIV-negative patients


Eight studies provided data to assess the diagnostic accuracy of NAAT and AFB microscopy compared with culture in HIV-positive patients suspected of having an MTB infection. Of these, 2 studies used in-house NAAT and 6 used commercial NAAT. Five of these studies were conducted in countries with a high incidence of TB and only 2 looked at the accuracy of NAAT in AFB-negative specimens (Figure 47 in Appendix D). Six studies provided data to assess the diagnostic accuracy of NAAT and AFB microscopy compared with culture in HIV-negative patients suspected of having an MTB infection, and all were conducted in countries with a high incidence of TB. Of these, 3 studies used in-house NAAT and 3 used commercial NAAT (Figure 48 in Appendix D). It should be noted that the Tuberculosis notifications in Australia, 2010 Annual Report11 stated that HIV and TB co-infection remains rare in Australia and is a relatively minor contributor to annual TB incidence, unlike in many other parts of the world.

The pooled sensitivity and specificity values for AFB microscopy or NAAT compared with culture in HIV-positive and -negative populations were compared with those for all included studies, which largely consisted of patients in whom their HIV status was unknown (Figure 26). There were no differences between the pooled values for the three population groups, indicating that HIV status does not affect the performance of either AFB microscopy or NAAT.



Forest plot showing the pooled sensitivity and specificity values for AFB and NAAT compared with culture according to HIV status

Figure 26 Forest plot showing the pooled sensitivity and specificity values for AFB and NAAT compared with culture according to HIV status



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