What constitutes a positive PPD in HIV disease?
Induration of 5mm or more at 48-72 hours constitutes a positive PPD test for tuberculosis in a person with HIV. A PPD should be done at baseline and repeated annually if the initial test was negative and the patient is in a high-risk category for tuberculosis. The test has a relatively high rate of false-negative results in patients with a CD4 cell count of <200/mm3. Therefore, if the initial test was done when the CD4 cell count was low, it should be repeated when the CD4 cell count increases to >200/mm3 following ART. Patients with a positive PPD test need a chest x-ray and evaluation for active disease before isoniazid (INH) prophylaxis is initiated. What is the role of a baseline chest x-ray? A chest x-ray is recommended for detection of latent or active tuberculosis and other lung diseases and as a baseline for patients who are at high risk for pulmonary disease, especially bacterial pneumonia, Pneumocystis pneumonia, and tuberculosis. The x-ray is particularly important for any p
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