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Sensitivity of the lateral flow urine lipoarabinomannan assay in ambulant adults with advanced HIV disease: data from the TB Fast Track study
| Content Provider | Oxford Academic |
|---|---|
| Author | Tlali, Mpho Fielding, Katherine L Karat, Aaron S Hoffmann, Christopher J Muravha, Tshifhiwa Grant, Alison D Charalambous, Salome |
| Copyright Year | 2020 |
| Abstract | Background: WHO guidelines recommend the lateral flow urine lipoarabinomannan assay (LF-LAM) for TB diagnosis in hospitalised HIV-positive individuals. The role of LF-LAM among ambulant patients remains less well defined. We investigated the sensitivity of LF-LAM among ambulant HIV-positive adults in primary health clinics in South Africa.MethodsWe enrolled adults (aged ≥18 y) with CD4 counts of ≤150 cells/mm3 who had not received TB treatment or antiretroviral therapy in the preceding 3 or 6 mo, respectively. Research nurses performed the LF-LAM test on freshly voided urine. Results were compared with a reference standard of positive mycobacterial culture (sputum or urine).ResultsOf 1505 (54.5% female; median age 37 y; median CD4 count 73 cells/mm3) participants, 973 (64.7%) had a mycobacterial culture result; 105/973 (10.8%) were positive for Mycobacterium tuberculosis. LF-LAM sensitivity was 41.9% (95% CI 32.3 to 51.9%) and 19.0% (95% CI 12.0 to 27.9%) using grade 1+ and grade 2+ cut-off points, respectively. Sensitivity increased with severe immunosuppression and in the presence of poor prognostic indicators (low haemoglobin, body mass index).ConclusionsWhen used as the only TB diagnostic test, LF-LAM sensitivity is suboptimal, particularly using the grade 2+ cut-off. More sensitive tests for TB are needed that can be used in primary care settings. |
| Related Links | https://academic.oup.com/trstmh/article-pdf/114/8/556/33568539/traa018.pdf |
| Ending Page | 560 |
| Starting Page | 556 |
| File Format | |
| ISSN | 00359203 |
| e-ISSN | 18783503 |
| DOI | 10.1093/trstmh/traa018 |
| Journal | Transactions of The Royal Society of Tropical Medicine and Hygiene |
| Issue Number | 8 |
| Volume Number | 114 |
| Language | English |
| Publisher | Oxford Academic |
| Publisher Date | 2020-08-01 |
| Access Restriction | Open |
| Subject Keyword | Clinical Medicine Infectious Diseases Medicine and Health Public Health and Epidemiology Adult Tuberculosis Urine Fluid Flow Lipoarabinomannan Diagnostic Techniques and Procedures South Africa Sputum Hiv Infections Cd4 Count Determination Procedure Algorithms Tb Diagnostic Tests Hiv |
| Content Type | Text |
| Resource Type | Article |
| Subject | Infectious Diseases Public Health, Environmental and Occupational Health Parasitology |
