Diagnosis Value Of Xpert MTB/RIF Assay For Tuberculosis In Patients With HIV-infection: An Meta Analysis

Objective : To evaluation the clinical value of diagnosis of Xpert MTB/RIF assay for tuberculosis in patients with HIV-infection.Methods:Studies about the diagnosic value of Xpert MTB/RIF assay to tuberculosis in HIV-infected patients were searched in Pub Med、Free Medical Journal Service(FMJS)、The Cochrane Library、China National Knoledge Infrastucture(CNKI)、 Wangfang data base and VIP Journal Intergration Plaform(VIJP)from establishment to March 2016.Preliminary retrieve relevant documents 170,according to inclusion and discharge criteria included in the final 10 documents.Two researchers independently performed data extraction and quality assessment,diagnostic accuracy study of the QUADAS scale is used for literature quality evaluation,Meta-Disc 1.4 software and Stata12.0 software are used for Meta analysis.Results:A total of 10 studies were recruited in the analysis,involving six different countries,including 1878 specimen from clinical patients.Meta analysis showed that the pooled sensitivity and specificity of Xpert MTB/RIF MTB/RIF test for the diagnosis of tuberculosis among patients with HIV-infection were 69%(95%CI:65%-72%)and 97%(95%CI:95%-98%),respectively,the area under the curve(AUC)of summary receiver operating characteristics(SROC)was 98%.According to different types of specimens collected from the subgroup analysis,Xpert MTB/RIF test pooled sensitivity and specificity for diagnosis tuberculosis in respiratory specimens was significantly higher than non-respiratory samples: pooled sensitivity was 76%(95% CI: 71%-80%)vs 62%(95% CI: 57%-67%),and pooled specificity was 98%(95% CI: 97%99%)vs94%(95% CI: 91%-96%).Six studies compared the Xpert MTB/RIF diagnostic performance with sputum smear acid-fast staining microscopic examination in HIV-infected patients and found that the sensitivity was higher than sputum smear acid-fast staining microscopic examination.Conclusions:Xpert MTB/RIF test was of high clinical value in diagnosis of tuberculosis in HIV-infected patients and influenced by different types of specimens.It was more sensitive and specific in respiratory specimens than in non-respiratory specimens,and the differences were statistical.Furthermore,the sensitivity of Xpert MTB/RIF test was higher than sputum smear acid-fast staining microscopic examination.