@article {Whitelaw1393, author = {A. Whitelaw and J. Peter and H. Sohn and D. Viljoen and G. Theron and M. Badri and V. Davids and M. Pai and K. Dheda}, title = {Comparative cost and performance of light-emitting diode microscopy in HIV{\textendash}tuberculosis-co-infected patients}, volume = {38}, number = {6}, pages = {1393--1397}, year = {2011}, doi = {10.1183/09031936.00023211}, publisher = {European Respiratory Society}, abstract = {Light-emitting diode (LED) microscopy has recently been endorsed by the World Health Organization (WHO). However, it is unclear whether LED is as accurate and cost-effective as Ziehl{\textendash}Neelsen (ZN) microscopy or mercury vapour fluorescence microscopy (MVFM) in tuberculosis (TB){\textendash}HIV-co-infected subjects. Direct and concentrated sputum smears from TB suspects were evaluated using combinations of LED microscopy, ZN microscopy and MVFM. Median reading time per slide was recorded and a cost analysis performed. Mycobacterial culture served as the reference standard. 647 sputum samples were obtained from 354 patients (88 (29.8\%) were HIV-infected and 161 (26\%) were culture-positive for Mycobacterium tuberculosis). Although overall sensitivity of LED compared with ZN microscopy or MVFM was similar, sensitivity of all three modalities was lower in HIV-infected patients. In the HIV-infected group, the sensitivity of LED microscopy was higher than ZN microscopy using samples that were not concentrated (46 versus 39\%; p=0.25), and better than MVFM using concentrated samples (56 versus 44; p=0.5). A similar trend was seen in the CD4 count \<200 cells{\textperiodcentered}mL-1 subgroup. Median (interquartile range) reading time was quicker with LED compared with ZN microscopy (1.8 (1.7{\textendash}1.9) versus 2.5 (2.2{\textendash}2.7) min; p<=0.001). Average cost per slide read was less for LED microscopy (US$1.63) compared with ZN microscopy (US$2.10). Among HIV{\textendash}TB-co-infected patients, LED microscopy was cheaper and performed as well as ZN microscopy or MVFM independent of the staining (ZN or auramine O) or processing methods used.}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/38/6/1393}, eprint = {https://erj.ersjournals.com/content/38/6/1393.full.pdf}, journal = {European Respiratory Journal} }