1921
Volume 102, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Point-of-care urine-lipoarabinomannan (LAM) Alere Determine TB-LAM assay has shown utility diagnosing tuberculosis (TB) in HIV-positive, severely immunocompromised, TB-symptomatic patients. We assessed LAM results in severely immunocompromised patients, who had LAM systematically performed at new or follow-up HIV consultations. This was a prospective, observational study on consecutive ambulatory, > 15-year-old HIV-positive patients with CD4 < 100 cells/µL in Mozambique. Clinical assessments and LAM were performed for all and microscopy, Xpert, sputum culture, and chest X-ray for LAM-positive participants. Patients were followed up for 6 months. Of 360 patients, half were ART-naive. Lipoarabinomannan positivity was 11.9% (43/360), higher among symptomatic patients compared with asymptomatic: 18.5% (30/162), and 6.6% (13/198), respectively, = 0.001. Tuberculosis was bacteriologically confirmed in 6/35 LAM-positive patients (2 of them asymptomatic). Lipoarabinomannan positivity was associated with higher risk of mortality (adjusted odds ratio [aOR]: 4.6, 95% CI: 1.3–15.6, = 0.015). Systematic urine-LAM allows for rapid TB treatment initiation in severely immunocompromised HIV ambulatory patients and identifies patients at a higher risk of death.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.19-0493
2020-01-20
2020-04-09
Loading full text...

Full text loading...

/deliver/fulltext/14761645/102/3/tpmd190493.html?itemId=/content/journals/10.4269/ajtmh.19-0493&mimeType=html&fmt=ahah

References

  1. World Health Organization, 2018. Global Tuberculosis Report 2018. Geneva, Switzerland: WHO.
    [Google Scholar]
  2. World Health Organization, 2011. Guidelines for Intensified Tuberculosis Case-Finding and Isoniazid Preventive Therapy for People Living with HIV in Resource-Constrained Settings. Geneva, Switzerland: WHO.
    [Google Scholar]
  3. World Health Organization, 2017. Guidelines for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy, July 2017. Geneva, Switzerland: WHO.
    [Google Scholar]
  4. Peter JG et al., 2016. Effect on mortality of point-of-care, urine-based lipoarabinomannan testing to guide tuberculosis treatment initiation in HIV-positive hospital inpatients: a pragmatic, parallel-group, multicountry, open-label, randomised controlled trial. Lancet 387: 11871197.
    [Google Scholar]
  5. Gupta-Wright A et al., 2018. Rapid urine-based screening for tuberculosis in HIV-positive patients admitted to hospital in Africa (STAMP): a pragmatic, multicentre, parallel-group, double-blind, randomised controlled trial. Lancet 392: 292301.
    [Google Scholar]
  6. Hanifa Y et al., 2016. Diagnostic accuracy of lateral flow urine LAM assay for TB screening of adults with advanced immunosuppression attending routine HIV care in South Africa. PLoS One 11: e0156866.
    [Google Scholar]
  7. Yoon C et al., 2019. Yield and efficiency of novel intensified tuberculosis case-finding algorithms for people living with HIV. Am J Respir Crit Care Med 199: 643650.
    [Google Scholar]
  8. Floridia M et al., 2017. Tuberculosis case finding with combined rapid point-of-care assays (Xpert MTB/RIF and determine TB LAM) in HIV-positive individuals starting antiretroviral therapy in Mozambique. Clin Infect Dis 65: 18781883.
    [Google Scholar]
  9. Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Bassett IV, 2016. Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis. BMC Pulm Med 16: 147.
    [Google Scholar]
  10. Bjerrum S, Kenu E, Lartey M, Newman MJ, Addo KK, Andersen AB, Johansen IS, 2015. Diagnostic accuracy of the rapid urine lipoarabinomannan test for pulmonary tuberculosis among HIV-infected adults in Ghana-findings from the DETECT HIV-TB study. BMC Infect Dis 15: 407.
    [Google Scholar]
  11. Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Walensky RP, Freedberg KA, Bassett IV, 2014. Diagnostic accuracy of a point-of-care urine test for tuberculosis screening among newly-diagnosed HIV-infected adults: a prospective, clinic-based study. BMC Infect Dis 14: 110.
    [Google Scholar]
  12. Balcha TT, Winqvist N, Sturegård E, Skogmar S, Reepalu A, Jemal ZH, Tibesso G, Schön T, Björkman P, 2014. Detection of lipoarabinomannan in urine for identification of active tuberculosis among HIV-positive adults in Ethiopian health centres. Trop Med Int Health 19: 734742.
    [Google Scholar]
  13. Lawn SD, Kerkhoff AD, Vogt M, Wood R, 2012. Diagnostic accuracy of a low-cost, urine antigen, point-of-care screening assay for HIV-associated pulmonary tuberculosis before antiretroviral therapy: a descriptive study. Lancet Infect Dis 12: 201209.
    [Google Scholar]
  14. Bjerrum S, Schiller I, Dendukuri N, Kohli M, Nathavitharana RR, Zwerling AA, Denkinger CM, Steingart KR, Shah M, 2019. Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in people living with HIV. Cochrane Database Syst Rev 10: CD011420.
    [Google Scholar]
  15. World Health Organization, 2019. Lateral Flow Urine Lipoarabinomannan Assay (LF-LAM) for the Diagnosis of Active Tuberculosis in People Living with HIV–Policy Update (2019). Available at: http://apps.who.int/bookorders. Accessed November 14, 2019.
    [Google Scholar]
  16. Firth D, 1993. Bias reduction of maximum likelihood estimates. Biometrika 80: 2738.
    [Google Scholar]
  17. Nel JS, Lippincott CK, Berhanu R, Spencer DC, Sanne IM, Ive P, 2017. Does disseminated nontuberculous mycobacterial disease cause false-positive determine TB-LAM lateral flow assay results? A retrospective review. Clin Infect Dis 65: 12261228.
    [Google Scholar]
  18. Gupta-Wright A, Kerkhoff AD, Meintjes G, Corbett EL, 2018. Urinary lipoarabinomannan detection and disseminated nontuberculous mycobacterial disease. Clin Infect Dis 66: 158.
    [Google Scholar]
  19. Gupta-Wright A, Peters JA, Flach C, Lawn SD, 2016. Detection of lipoarabinomannan (LAM) in urine is an independent predictor of mortality risk in patients receiving treatment for HIV-associated tuberculosis in sub-Saharan Africa: a systematic review and meta-analysis. BMC Med 14: 53.
    [Google Scholar]
  20. Lawn SD, Gupta-Wright A, 2015. Detection of lipoarabinomannan (LAM) in urine is indicative of disseminated TB with renal involvement in patients living with hiv and advanced immunodeficiency: evidence and implications. Trans R Soc Trop Med Hyg 110: 180185.
    [Google Scholar]
  21. Lawn SD, 2012. Point-of-care detection of lipoarabinomannan (LAM) in urine for diagnosis of HIV-associated tuberculosis: a state of the art review. BMC Infect Dis 12: 103.
    [Google Scholar]
  22. Mathabire Rucker SC et al., 2019. Feasibility of using Determine TB-LAM to diagnose tuberculosis in HIV-positive patients in programmatic conditions: a multisite study. Glob Health Action 12: 1672366.
    [Google Scholar]
  23. Kranzer K, Houben RM, Glynn JR, Bekker L-G, Wood R, Lawn SD, 2010. Yield of HIV-associated tuberculosis during intensified case finding in resource-limited settings: a systematic review and meta-analysis. Lancet Infect Dis 10: 93102.
    [Google Scholar]
  24. Mtei L et al., 2005. High rates of clinical and subclinical tuberculosis among HIV-infected ambulatory subjects in Tanzania. Clin Infect Dis 40: 15001507.
    [Google Scholar]
  25. Wood R, Middelkoop K, Myer L, Grant AD, Whitelaw A, Lawn SD, Kaplan G, Huebner R, McIntyre J, Bekker L-G, 2007. Undiagnosed tuberculosis in a community with high HIV prevalence: implications for tuberculosis control. Am J Respir Crit Care Med 175: 8793.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.19-0493
Loading
/content/journals/10.4269/ajtmh.19-0493
Loading

Data & Media loading...

  • Received : 01 Jul 2019
  • Accepted : 02 Dec 2019
  • Published online : 20 Jan 2020
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error