Figure 1

Algorithm for the diagnosis of tuberculosis in ambulatory HIV-positive patients using Xpert MTB/RIF.¹Among adults and adolescents living with HIV, a TB suspect is defined as a person who reports any one of current cough, fever, weight loss or night sweats. Among children living with HIV, a TB suspect is defined as a person who reports one of poor weight gain, fever, current cough, or history of contact with a TB case. ²In all persons with unknown HIV status, HIV testing should be performed according to national guidelines. In patients who are HIV negative or remain HIV unknown (e.g., refusal), a TB suspect is defined according to national case definitions. A person with unknown HIV status can still be classified as HIV-positive if there is strong clinical evidence of HIV infection. ³The danger signs include any one of: respiratory rate >30/min, temperature >39°C, heart rate >120/min and unable to walk unaided. ⁴CPT = cotrimoxazole preventive therapy. ⁵ART = antiretroviral therapy. All TB patients living with HIV are eligible for ART irrespective of CD4 count. Start TB treatment first, followed by ART as soon as possible within the first 8 weeks of TB treatment. See ART guidelines. ⁶In low MDR-TB prevalence settings, a confirmatory test for rifampicin resistance should be performed. See MDR-TB Xpert MTB/RIF algorithm. ⁷A chest x-ray can assist with the diagnosis of extra-pulmonary TB (e.g., pleural, pericardial) and help assess for other etiologies of respiratory illness. It should only be performed in those settings where the quality of the film and its interpretation are assured. ⁸Antibiotics (except fluoroquinolones) to cover both typical and atypical bacteria should be considered. ⁹An HIV treatment assessment includes WHO clinical staging and/or CD4 count to assess eligibility for antiretroviral therapy. See ART guidelines. ¹⁰PCP= Pneumocystis jirovecii pneumonia.