03.04.2025
New test improves tuberculosis diagnosis in adults living with HIV
A molecular stool test, previously used primarily in children, is showing promising results for the diagnosis of tuberculosis in HIV-positive adults. This is the key finding of the international stool4TB study, conducted in Mozambique, Uganda, and Eswatini, with participation from the Research Center Borstel.
Funded by the European Union, the study investigated the use of the Xpert MTB/Ultra test on stool samples from 677 HIV-positive patients over the age of 15 with suspected pulmonary tuberculosis. The method offers an alternative to the standard diagnostic approach using sputum samples—a procedure that often fails in people living with HIV, as many are unable to produce sputum or the bacterial load in the sample is too low for detection. The results showed that the stool test achieved a sensitivity of 23.7% and a high specificity of 94.0%. Notably, among individuals with weakened immune systems (CD4 count < 200 cells/μl), sensitivity increased to 45.5%. The test also identified tuberculosis cases that went undetected by other diagnostic methods.
According to Collins Musia of the Research Center Borstel, one of the scientists involved in the stool4TB Global Partnership, the test represents a promising addition to existing diagnostic tools—particularly in regions with limited laboratory access and among patients with advanced HIV disease. “The study results could make an important contribution to improving early detection of tuberculosis in people living with HIV and open new opportunities for the use of non-invasive diagnostics in resource-limited settings,” Musia stated.
Publication:
Kasule GW, Hermans S, Acacio S, Kay A, Nsubuga J, Fernández-Escobar C, Shiba N, Carratala Castro L, Semugenze D, Mwachan P, Munguambe S, Ehrlich J, Lopez-Varela E, Dinardo A, Cobelens F, Lange C, Joloba M, Mandalakas A, Ssengooba W, García-Basteiro AL on behalf of the Stool4TB Global Partnership. Performance of stool Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis among adult people living with HIV: a prospective multicentre diagnostic study https://doi.org/10.1016/j.lanmic.2025.101085
Contact:
Collins Musia MPH
Klinische Infektiologie
Forschungszentrum Borstel, Leibniz Lungenzentrum
Parkallee 35
23845 Borstel