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


Lawn, SD; Kerkhoff, AD; Vogt, M; Wood, R; (2012) Clinical significance of lipoarabinomannan (LAM) detection in urine using a low-cost point-of-care diagnostic assay for HIV-associated tuberculosis. AIDS (London, England). ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0b013e3283553685

Full text not available from this repository.

Abstract

: OBJECTIVE:: 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. METHODS:: 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 centralised 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 counts?<?200?cells/?L. RESULTS:: Of patients with CD4 counts?<?200?cells/?L 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 counts, higher plasma viral loads, lower haemoglobin concentrations and lower body mass indices compared to those with LAM-negative TB. They also had evidence of higher mycobacterial load, more frequently testing sputum smear-positive, Xpert-positive (sputum and urine) and having a shorter time to sputum culture positivity. Of 5 (8.5%) patients who died, 4 did so before TB treatment was started. All 5 retrospectively tested LAM-positive. CONCLUSIONS:: A low-cost point-of-care urine test for LAM rapidly diagnoses a sub-group of cases with advanced HIV-associated TB and poor prognosis. If used in combination with laboratory-based diagnostics, treatment delays would decrease and survival might be improved.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 22555166
Web of Science ID: 307532100006
URI: http://researchonline.lshtm.ac.uk/id/eprint/20855

Statistics


Download activity - last 12 months
Downloads since deposit
0Downloads
275Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item