Urine lipoarabinomannan assay for tuberculosis screening before antiretroviral therapy diagnostic yield and association with immune reconstitution disease

AIDS
Stephen D LawnRobin Wood

Abstract

To assess the utility of urine lipoarabinomannan (LAM) detection as a diagnostic screening test for tuberculosis (TB) in HIV-infected patients with advanced immuno deficiency and high prevalence of sputum smear-negative pulmonary disease. Cross-sectional survey. Unselected adults enrolling for antiretroviral therapy (ART) in a South African clinic were screened for TB with two sputum samples for fluorescence microscopy and mycobacterial liquid culture. LAM was measured in urine samples using a commercially available enzyme-linked immunosorbent assay. Sputum culture-positive TB was diagnosed in 58 patients (median CD4 cell count=78 cells/microliter) out of 235 patients screened (TB prevalence=0.25). Cultures were identified as positive after a mean of 24 days (SD=9 days). The sensitivity of sputum microscopy was just 0.14 (specificity=1.00), whereas that of LAM in concentrated urine was 0.38 (P<0.01; specificity=1.00). In those with CD4 cell counts of less than 50, 50-100 and more than 150 cells/microliter, the LAM assay sensitivities were 0.67, 0.41 and 0.13, respectively. Corresponding values for the combined use of the LAM assay and microscopy were 0.67, 0.53 and 0.21, respectively. Among TB patients, detectable LAM was very ...Continue Reading

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Citations

Sep 17, 2011·Transactions of the Royal Society of Tropical Medicine and Hygiene·Nicole T BurtonAwewura Kwara
Nov 1, 2011·The Lancet Infectious Diseases·Jennifer UyeiSally Guttmacher
Feb 18, 2011·Nature Reviews. Microbiology·Ruth McNerney, Peter Daley
Dec 17, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Stephen D LawnRobin Wood
Dec 23, 2011·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Stephen D Lawn, Robin Wood
Sep 8, 2012·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Molebogeng X RangakaGary Maartens
Oct 26, 2011·The Journal of Infectious Diseases·Jacqueline M Achkar, Elizabeth R Jenny-Avital
Apr 13, 2012·The Journal of Infectious Diseases·Ruth McNerneyAlimuddin Zumla
Feb 15, 2012·The Pediatric Infectious Disease Journal·Delane Shingadia
Mar 27, 2013·Current Opinion in Pulmonary Medicine·Stephen D Lawn
Aug 21, 2009·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Maunank ShahNeil A Martinson
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