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Failure to recognize active tuberculosis (TB) at the start of antiretroviral therapy (ART) can increase the risk for severe illness and premature death — and, in crowded clinics, can facilitate the spread of TB. The WHO currently recommends TB screening for all HIV-infected patients who have a cough lasting at least 2 or 3 weeks. However, such symptom-based algorithms fall short in patients with asymptomatic disease (e.g., those with subclinical pulmonary TB). A study conducted in a Durban, South Africa, clinic demonstrates just how problematic this scenario is.
All 825 patients who were about to initiate ART between May 2007 and May 2008 and who were not receiving TB therapy had a single sputum specimen obtained prior to physician evaluatio…