Abstract | OBJECTIVE: DESIGN: Analysis of baseline blood samples in a randomized strategy study of patients with acute opportunistic infections, limited to participants with respiratory symptoms. METHODS: Participants in the 282-person ACTG A5164 trial had baseline plasma samples assayed for beta-glucan testing. As part of A5164 trial, two study investigators independently adjudicated the diagnosis of PCP. Respiratory symptoms were identified by investigators from a list of all signs and symptoms with an onset or resolution in the 21 days prior to or 14 days following study entry. Beta-glucan was defined as positive if at least 80 pg/ml and negative if less than 80 pg/ml. RESULTS: Of 252 study participants with a beta-glucan result, 159 had at least one respiratory symptom, 139 of whom had a diagnosis of PCP. The sensitivity of beta-glucan for PCP in participants with respiratory symptoms was 92.8% [95% confidence interval (CI) 87.2-96.5], and specificity 75.0% (95% CI 50.9-91.3). Among 134 individuals with positive beta-glucan and respiratory symptoms, 129 had PCP, for a positive predictive value of 96.3% (95% CI 91.5-98.8). Fifteen of 25 patients with a normal beta-glucan did not have PCP, for a negative predictive value of 60% (95% CI 38.7-78.9). CONCLUSION: Elevated plasma beta-glucan has a high predictive value for diagnosis of PCP in AIDS patients with respiratory symptoms. We propose an algorithm for the use of beta-glucan as a diagnostic tool on the basis of the pretest probability of PCP in such patients.
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Authors | Brian R Wood, Lauren Komarow, Andrew R Zolopa, Malcolm A Finkelman, William G Powderly, Paul E Sax |
Journal | AIDS (London, England)
(AIDS)
Vol. 27
Issue 6
Pg. 967-972
(Mar 27 2013)
ISSN: 1473-5571 [Electronic] England |
PMID | 23698062
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- AIDS-Related Opportunistic Infections
(diagnosis, pathology)
- Acquired Immunodeficiency Syndrome
(complications)
- Biomarkers
(blood)
- Humans
- Plasma
(chemistry)
- Pneumocystis carinii
(chemistry)
- Pneumonia, Pneumocystis
(diagnosis, pathology)
- Predictive Value of Tests
- Randomized Controlled Trials as Topic
- beta-Glucans
(blood)
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