• Login
    View Item 
    •   Home
    • 1 Published Research and Commentary
    • HIV/AIDS
    • View Item
    •   Home
    • 1 Published Research and Commentary
    • HIV/AIDS
    • View Item
    Mar 03, 2021
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of MSFTitleAuthorsSubjectsPublisherJournalThis CollectionTitleAuthorsSubjectsPublisherJournal

    Diagnostic value of the urine lipoarabinomannan assay in HIV-positive, ambulatory patients with CD4 below 200 cells/μl in 2 low-resource settings: A prospective observational study.

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Thumbnail
    Name:
    Huerga et al - 2019 - Diagnostic ...
    Size:
    1.114Mb
    Format:
    PDF
    Download
    Authors
    Huerga, H
    Mathabire Rucker, SC
    Cossa, L
    Bastard, M
    Amoros, I
    Manhica, I
    Mbendera, K
    Telnov, A
    Szumilin, E
    Sanchez-Padilla, E
    Molfino, L
    Show allShow less
    Issue Date
    2019-04-30
    Submitted date
    2019-05-30
    
    Metadata
    Show full item record
    Journal
    PLoS Medicine
    Abstract
    BACKGROUND: Current guidelines recommend the use of the lateral flow urine lipoarabinomannan assay (LAM) in HIV-positive, ambulatory patients with signs and symptoms of tuberculosis (TB) only if they are seriously ill or have CD4 count ≤ 100 cells/μl. We assessed the diagnostic yield of including LAM in TB diagnostic algorithms in HIV-positive, ambulatory patients with CD4 < 200 cells/μl, as well as the risk of mortality in LAM-positive patients who were not diagnosed using other diagnostic tools and not treated for TB. METHODS AND FINDINGS: We conducted a prospective observational study including HIV-positive adult patients with signs and symptoms of TB and CD4 < 200 cells/μl attending 6 health facilities in Malawi and Mozambique. Patients were included consecutively from 18 September 2015 to 27 October 2016 in Malawi and from 3 December 2014 to 22 August 2016 in Mozambique. All patients had a clinical exam and LAM, chest X-ray, sputum microscopy, and Xpert MTB/RIF assay (Xpert) requested. Culture in sputum was done for a subset of patients. The diagnostic yield was defined as the proportion of patients with a positive assay result among those with laboratory-confirmed TB. For the 456 patients included in the study, the median age was 36 years (IQR 31-43) and the median CD4 count was 50 cells/μl (IQR 21-108). Forty-five percent (205/456) of the patients had laboratory-confirmed TB. The diagnostic yields of LAM, microscopy, and Xpert were 82.4% (169/205), 33.7% (69/205), and 40.0% (84/205), respectively. In total, 50.2% (103/205) of the patients with laboratory-confirmed TB were diagnosed only through LAM. Overall, the use of LAM in diagnostic algorithms increased the yield of algorithms with microscopy and with Xpert by 38.0% (78/205) and 34.6% (71/205), respectively, and, specifically among patients with CD4 100-199 cells/μl, by 27.5% (14/51) and 29.4% (15/51), respectively. LAM-positive patients not diagnosed through other tools and not treated for TB had a significantly higher risk of mortality than LAM-positive patients who received treatment (adjusted risk ratio 2.57, 95% CI 1.27-5.19, p = 0.009). Although the TB diagnostic conditions in the study sites were similar to those in other resource-limited settings, the added value of LAM may depend on the availability of microscopy or Xpert results. CONCLUSIONS: LAM has diagnostic value for identifying TB in HIV-positive patients with signs and symptoms of TB and advanced immunodeficiency, including those with a CD4 count of 100-199 cells/μl. In this study, the use of LAM enabled the diagnosis of TB in half of the patients with confirmed TB disease; without LAM, these patients would have been missed. The rapid identification and treatment of TB enabled by LAM may decrease overall mortality risk for these patients.
    Publisher
    Public Library of Science
    URI
    http://hdl.handle.net/10144/619385
    DOI
    10.1371/journal.pmed.1002792
    PubMed ID
    31039161
    Language
    en
    ISSN
    1549-1676
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pmed.1002792
    Scopus Count
    Collections
    HIV/AIDS

    entitlement

    Related articles

    • Should Urine-LAM Tests Be Used in TB Symptomatic HIV-Positive Patients When No CD4 Count Is Available? A Prospective Observational Cohort Study From Malawi.
    • Authors: Huerga H, Rucker SCM, Bastard M, Dimba A, Kamba C, Amoros I, Szumilin E
    • Issue date: 2020 Jan 1
    • Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in HIV-positive adults.
    • Authors: Shah M, Hanrahan C, Wang ZY, Dendukuri N, Lawn SD, Denkinger CM, Steingart KR
    • Issue date: 2016 May 10
    • Diagnostic accuracy, incremental yield and prognostic value of Determine TB-LAM for routine diagnostic testing for tuberculosis in HIV-infected patients requiring acute hospital admission in South Africa: a prospective cohort.
    • Authors: Lawn SD, Kerkhoff AD, Burton R, Schutz C, Boulle A, Vogt M, Gupta-Wright A, Nicol MP, Meintjes G
    • Issue date: 2017 Mar 21
    • Test characteristics and potential impact of the urine LAM lateral flow assay in HIV-infected outpatients under investigation for TB and able to self-expectorate sputum for diagnostic testing.
    • Authors: Peter J, Theron G, Chanda D, Clowes P, Rachow A, Lesosky M, Hoelscher M, Mwaba P, Pym A, Dheda K, TB-NEAT team.
    • Issue date: 2015 Jul 9
    • Diagnostic accuracy of a low-cost, urine antigen, point-of-care screening assay for HIV-associated pulmonary tuberculosis before antiretroviral therapy: a descriptive study.
    • Authors: Lawn SD, Kerkhoff AD, Vogt M, Wood R
    • Issue date: 2012 Mar
    DSpace software (copyright © 2002 - 2021)  DuraSpace
    Quick Guide | Contact Us
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.