Clinical significance of lipoarabinomannan detection in urine using a low-cost point-of-care diagnostic assay for HIV-associated tuberculosis

AIDS
Stephen D LawnRobin Wood

Abstract

A low-cost point-of-care urine assay for lipoarabinomannan (LAM) used for screening patients prior to antiretroviral therapy (ART) rapidly diagnoses a proportion of tuberculosis (TB) cases. We determined the characteristics and outcomes of such patients. Adults enrolling in a South African township ART clinic were systematically screened for pulmonary TB by testing paired sputum samples using microscopy, liquid culture and Xpert MTB/RIF in a centralized laboratory. Stored urine samples were retrospectively tested for LAM using the Determine TB-LAM assay, but results did not inform treatment. Patients were followed up in the routine ART service and early (90-day) programmatic outcomes were determined. Analysis was restricted to those with CD4 cell counts below 200 cells/μl. Of patients with CD4 cell counts below 200 cells/μl and complete results (n=325), 59 (18.2%) had culture-positive TB. Of these, 23 (39%) patients tested urine LAM-positive and 36 (61%) urine LAM-negative. Patients with LAM-positive TB had much lower CD4 cell counts, higher plasma viral loads, lower haemoglobin concentrations and lower BMIs compared to those with LAM-negative TB. They also had evidence of higher mycobacterial load, more frequently testing sput...Continue Reading

References

Sep 6, 2005·Transactions of the Royal Society of Tropical Medicine and Hygiene·C BoehmeM Hoelscher
Aug 17, 2006·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Stephen D LawnRobin Wood
Feb 28, 2009·The Lancet Infectious Diseases·Michael J A Reid, N Sarita Shah
Aug 26, 2010·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Ingrid V BassettKenneth A Freedberg
Sep 10, 2010·The New England Journal of Medicine·Catharina C BoehmeMark D Perkins
Oct 19, 2011·The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·A TrébucqH L Rieder
Feb 10, 2012·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Stephen D LawnRobin Wood
Apr 18, 2012·The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·Stephen D LawnRobin Wood

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Citations

Jun 22, 2013·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Jason R AndrewsRochelle P Walensky
Mar 27, 2013·Current Opinion in Pulmonary Medicine·Stephen D Lawn
Jan 17, 2014·Postgraduate Medical Journal·Pronoti SarkarBarnali Kakati
Sep 26, 2013·Journal of the International Association of Providers of AIDS Care·Tara Vijayan, Jeffrey D Klausner
Nov 30, 2012·Respirology : Official Journal of the Asian Pacific Society of Respirology·Keertan DhedaWing Cheong Yam
Sep 5, 2015·Journal of Immunology Research·Jingge ZhaoToshio Hattori
May 12, 2015·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Stephen D LawnGraeme Meintjes
Dec 10, 2014·Current Opinion in Infectious Diseases·Adeeba Kamarulzaman, Frederick L Altice
Dec 9, 2016·The American Journal of Tropical Medicine and Hygiene·Yukari C ManabeFrank Cobelens
Apr 4, 2018·The Journal of Immunology : Official Journal of the American Association of Immunologists·Alok ChoudharyAbraham Pinter
Jan 23, 2014·The Cochrane Database of Systematic Reviews·Karen R SteingartNandini Dendukuri
May 11, 2016·The Cochrane Database of Systematic Reviews·Maunank ShahKaren R Steingart
Apr 18, 2014·Clinical and Vaccine Immunology : CVI·Stephen D Lawn
Aug 20, 2020·Scientific Reports·Ruben MagniAlessandra Luchini
Jun 8, 2019·The Cochrane Database of Systematic Reviews·David J HorneKaren R Steingart
Oct 22, 2019·The Cochrane Database of Systematic Reviews·Stephanie BjerrumMaunank Shah

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