Detection of lipoarabinomannan in urine for identification of active tuberculosis among <scp>HIV</scp>‐positive adults in <scp>E</scp>thiopian health centres

Balcha, Taye Tolera; Winqvist, Niclas; Sturegård, Erik; Skogmar, Sten; Reepalu, Anton; Jemal, Zelalem Habtamu; Tibesso, Gudeta; Schӧn, Thomas; Björkman, Per

doi:10.1111/tmi.12308

Cited by 31 publications

(36 citation statements)

References 26 publications

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“…Extrapulmonar tuberculosis (EPTB) was seen among 11.4% (95% CI:8.1-14.4) of patients in our study, which is similar to the global figure of 13% on all TB cases reported by WHO [22], but low compared to what is seen in study with 757 patients with HIV in Ethiopia with 25% (95% CI:19.7-30.3) [23]. We found that in our cases the most common types of EPTB were lymphadenitis (53%) and pleural TB (18%).…”

Section: Discussionsupporting

confidence: 86%

High prevalence and low cure rate of tuberculosis among patients with HIV in Xinjiang, China

et al. 2017

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BackgroundTuberculosis and HIV co-epidemics are problems in many parts of the world. Xinjiang is a high tuberculosis and HIV prevalence area in China. We aimed to investigate the prevalence and cure rate of tuberculosis among HIV positive patients in Xinjiang.MethodsIn a retrospective study between 2006 and 2011, clinical and laboratory data on 333 patients with HIV and tuberculosis were compared to 2668 patients with HIV only. There were 31 HIV positive patients with no data on tuberculosis.ResultsThe prevalence of tuberculosis co-infection among the HIV positive patients was 11% (95% CI 10–12%), significantly higher than the national figure in China of 2%. In most cases HIV was diagnosed late, with advanced immunodeficiency. The use of isoniazid preventive therapy was only 57.9% in patients without tuberculosis who fulfilled the criteria for receiving this prevention. The cure rate one year after diagnosis was 69.2%, which was lower than the officially reported 91.4% in all tuberculosis cases in Xinjiang in 2011. The hazard of not surviving over the five years was significantly higher in patients with HIV + tuberculosis compared to HIV only after adjusting for sex and Intravenous drug use with HR = 1.84 (95% CI 1.43-2.35; p < 0.0001).ConclusionsThe prevalence of tuberculosis among HIV positive patients in Xinjiang was higher than in China taken as a whole, and HIV was diagnosed late, with underuse of isoniazid preventive therapy. The low cure rate and reduced survival can be due to late diagnosis of HIV and no testing for antibiotic resistance, together with insufficient control of adherence to the treatment regimens for tuberculosis and HIV.

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Section: Discussionsupporting

confidence: 86%

High prevalence and low cure rate of tuberculosis among patients with HIV in Xinjiang, China

et al. 2017

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“…25 Others have reported urine LAM testing to complement sputum AFB testing among symptomatic patients. 29,30 Given that the implementation of clinic-based urine LAM testing is likely easier and less expensive that clinic-based sputum AFB testing, we evaluated a sequential screening in which the urine LAM test would be performed first. Then, the optimal screening strategy was either a single urine LAM test or one urine LAM test followed by sputum AFB for a negative (grade <1+) LAM test.…”

Section: Discussionmentioning

confidence: 99%

Value of Urine Lipoarabinomannan Grade and Second Test for Optimizing Clinic-Based Screening for HIV-Associated Pulmonary Tuberculosis

Drain

Losina

Coleman

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background We assessed the role of urine LAM (lipoarabinomannan) grade and a second LAM test for HIV-associated pulmonary tuberculosis (TB) screening in outpatient clinics in South Africa. Methods We enrolled newly-diagnosed HIV-infected adults (≥18 years) at 4 clinics, excluding those on TB therapy. Participants provided sputum for AFB microscopy and culture. Nurses conducted two rapid urine LAM tests at the point-of-care, and graded positive results from low (“faint”) to high (5+). Culture-confirmed pulmonary TB was the gold standard. We used area under receiver operating curves (AUROC) to compare screening strategies. Results Among 320 HIV-infected adults, median CD4 was 248/mm3 (IQR 107–379/mm3); 54 (17%) were TB culture-positive. 52 (16%) of all participants were LAM-positive by either test; correlation between LAM tests was high. Among 10 “faint” positive results, 2 (20%) had culture-positive TB. Using ≥1+ LAM grade as positive, one LAM test had sensitivity of 41% (95% CI 28–55%) and specificity of 92% (95% CI 88–95%). A 2 LAM test strategy had a sensitivity of 43% (95% CI 29–57%). One LAM test ≥1+ grade (AUROC=0.66; 95% CI 0.60–0.73) was significantly better than sputum AFB alone. The optimal strategy was sequentially performing one LAM test followed by sputum AFB if LAM grade <1+ (AUROC=0.70; 95% CI 0.63–0.77), which had sensitivity of 48% (95% CI 34–62%) and specificity of 91% (95% CI 87–94%). Conclusions In this clinic-based study, “faint” line was a false-positive, second urine LAM test added no value, and an optimal screening strategy was one LAM test followed by sputum AFB microscopy for urine LAM-negative people.

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“…It can be applied directly on urine and provides a result within 30 minutes. Previous LAM performance studies have reported great variation in test sensitivity and specificity [ 12 – 19 ]. A consensus paper on the LAM test highlights issues with its performance and appropriate target group and calls for further evaluations of the LAM test in diverse settings [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of the rapid urine lipoarabinomannan test for pulmonary tuberculosis among HIV-infected adults in Ghana–findings from the DETECT HIV-TB study

et al. 2015

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BackgroundRapid diagnostic tests are urgently needed to mitigate HIV-associated tuberculosis (TB) mortality. We evaluated diagnostic accuracy of the rapid urine lipoarabinomannan (LAM) test for pulmonary TB and assessed the effect of a two-sample strategy.MethodsHIV-infected adults eligible for antiretroviral therapy were prospectively enrolled from Korle-Bu Teaching Hospital in Ghana and followed for minimum 6 months. We applied the LAM test on urine collected as a spot and early morning sample. Diagnostic accuracy was analysed for a microbiological TB reference standard based on sputum culture and Gene Xpert MTB/RIF results and for a composite reference standard including clinical follow-up data. Performance of sputum smear microscopy was included for comparison.ResultsOf 469 patients investigated for TB, the LAM test correctly identified 24/55 (44 %) of microbiologically confirmed TB cases. Sensitivity of the LAM test was positively associated with hospitalisation (67 %), Modified Early Warning Score > 4 (57 %) and subsequent death (71 %). LAM test specificity was 95 % increasing to 98 % for the composite reference standard. A two-sample LAM test strategy did not improve test performance. Using concentrated sputum for Ziehl-Neelsen and fluorescence microscopy in combination yielded a sensitivity of 31/55 (56 %) that increased to 35/55 (64 %) when the LAM test was added. Surprisingly, nontuberculous mycobacteria were cultured in 34/469 (7 %) and associated with a positive LAM test (p = 0.008).ConclusionsLAM test sensitivity was highest in patients with poor prognosis and subsequent death and did not increase with a two-sample strategy. A rigorous sputum microscopy strategy had superior sensitivity, but the simplicity of the LAM test holds operational possibilities as a TB screening method among severely sick patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1151-1) contains supplementary material, which is available to authorized users.

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Detection of lipoarabinomannan in urine for identification of active tuberculosis among HIV‐positive adults in Ethiopian health centres

Cited by 31 publications

References 26 publications

High prevalence and low cure rate of tuberculosis among patients with HIV in Xinjiang, China

High prevalence and low cure rate of tuberculosis among patients with HIV in Xinjiang, China

Value of Urine Lipoarabinomannan Grade and Second Test for Optimizing Clinic-Based Screening for HIV-Associated Pulmonary Tuberculosis

Diagnostic accuracy of the rapid urine lipoarabinomannan test for pulmonary tuberculosis among HIV-infected adults in Ghana–findings from the DETECT HIV-TB study

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