Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe

BMC Infectious Diseases
Lynn Sodai ZijenahK Dheda

Abstract

In Zimbabwe, sputum smear microscopy (SSM) is the routinely used TB diagnostic tool in hospitalised HIV-infected patients. However, SSM has poor sensitivity in HIV-infected patients. We compared performance of urine lipoarabinomannan strip test (LAM) and SSM among hospitalized HIV-infected patients with suspected TB. Hospitalized HIV-infected patients with suspected TB were randomized to LAM plus SSM or SSM alone groups as part of a larger multi-country parent study. Here we present a comparison of LAM versus SSM performance from the Zimbabwe study site. LAM analyses (grade 2 cut-off) were conducted using (i) a microbiological reference standard (MRS; culture positivity for M.tb and designated definite TB) and (ii) a composite reference standard (CRS; definite TB plus probable TB i.e. patients with clinical TB excluded from the culture negative group). CRS constituted the primary analysis. 82/457 (18%) of the patients randomized to the LAM group were M.tuberculosis culture positive. Using CRS, sensitivity (%, 95% CI) of LAM was significantly higher than SSM [49.2 (42.1-56.4) versus 29.4(23.2-36.3); p < 0.001]. Specificity and PPV were 98.1%, and 95.8%, respectively. By contrast, using MRS, LAM sensitivity was similar to SSM and...Continue Reading

References

Jun 28, 2011·The European Respiratory Journal·J MinionD Menzies
Mar 29, 2014·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Lydia NakiyingiSusan E Dorman
Apr 2, 2014·Tropical Medicine & International Health : TM & IH·Taye T BalchaPer Björkman

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Citations

Nov 4, 2016·NPJ Primary Care Respiratory Medicine·Giorgia SulisGiovanni Battista Migliori
Oct 7, 2016·AIDS Research and Therapy·Narendran GopalanSrikanth Tripathy
Oct 22, 2019·The Cochrane Database of Systematic Reviews·Stephanie BjerrumMaunank Shah

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Clinical Trials Mentioned

NCT01770730

Software Mentioned

Gene Xpert
MS Access
Alere
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