Diagnostic value of macrogene second generation sequencing in suspected tuberculosis in HIV/AIDS patients

LIU Biao; HE Xiangxi; XIE Xiaoxin; SONG Yebing; HE Jinhong; LONG Hai

doi:10.3969/j.issn.1007-8134.2024.05.003

Abstract：Objective To evaluate the diagnostic performance of metagenomic next-generation sequencing(mNGS)in the diagnosis of tuberculosis among HIV/AIDS patients.Methods From May 1,2021 to July 1,2023,HIV/AIDS patients suspected to be complicated with tuberculosis were selected,and sputum and bronchoalveolar lavage fluid(bronchoalveolar lavage fluid,BALF),cerebrospinal fluid,pleural effusion and peripheral blood were examined by mNGS,acid-fast staining smear,BALF MTB DNA,culture of Mycobacterium tuberculosis,MTB)and Xpert MTB/RIF(Xpert for short).A total of 104 suspected tuberculosis patients were included,with the final clinical diagnosis of tuberculosis as the gold standard,with 54 cases of tuberculosis and 50 cases of non-tuberculosis.Compare and analyze the difference of diagnostic efficiency between mNGS and different diagnostic methods.Results The sensitivity,specificity,Jordan index,positive predictive value and negative predictive value of mNGS in the diagnosis of tuberculosis were 69.0%(95%CI:54.0%～80.0%),90.0%(95%CI:78.0%～97.0%),0.59 and 88.00%(95%CI:74.0%～95%),73.0%(95%CI:60.0%～83.0%),respectively.The sensitivity,specificity,Jordan index,positive predictive value and negative predictive value of mNGS combined with Xpert in the diagnosis of tuberculosis were 76.0%(95%CI:62.0%～87.0%),88.0%(95%CI:76.0%～95.0%),0.64 and 87.0%(95%CI:74.0%～95.0%),77.0%(95%CI:64.0%～87.0%),respectively.The total sensitivity of mNGS,mNGS combined with Xpert was higher than that of Xpert(7.0%)and traditional detection method(43.0%).Conclusions mNGS demonstrates high diagnostic value for tuberculosis in HIV/AIDS patients,particularly for those suspected of extrapulmonary tuberculosis with negative Xpert results.Combining mNGS with Xpert can improve diagnostic accuracy in such cases.