Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis

BMC Pulmonary Medicine

Research Article

Sharon M. Coleman¹  Paul K. Drain²  Janet Giddy³  Douglas Ross⁴  Jeffrey N. Katz⁵  Elena Losina⁶  Ingrid V. Bassett⁷ 

[1] Boston University School of Public Health, Boston, USA;Department of Global Health, University of Washington, UW Box 359927, 325 Ninth Ave, 98104-2420, Seattle, WA, USA;Department of Medicine, University of Washington, Seattle, WA, USA;Department of Epidemiology, University of Washington, Seattle, WA, USA;Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA;Department of Medicine, McCord Hospital, Durban, South Africa;Department of Medicine, St. Mary’s Hospital, Durban, South Africa;Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA;Medical Practice Evaluation Center, Harvard Medical School, Boston, USA;Division of General Internal Medicine, Harvard Medical School, Boston, USA;Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA;Medical Practice Evaluation Center, Harvard Medical School, Boston, USA;Division of Infectious Diseases, Harvard Medical School, Boston, USA;Division of General Internal Medicine, Harvard Medical School, Boston, USA;

关键词: Tuberculosis;    HIV/AIDS;    Lipoarabinomannan (LAM);    Urine;    Diagnostic screening;    South Africa;   

DOI  :  10.1186/s12890-016-0316-z

 received in 2016-06-27, accepted in 2016-11-07,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundWorld Health Organization (WHO) recommends tuberculosis (TB) screening at HIV diagnosis. We evaluated the inclusion of rapid urine lipoarabinomannan (LAM) testing in TB screening algorithms.MethodsWe enrolled ART-naïve adults who screened HIV-infected in KwaZulu-Natal, assessed TB-related symptoms (cough, fever, night sweats, weight loss), and obtained sputum specimens for mycobacterial culture. Trained nurses performed clinic-based urine LAM testing using a rapid assay. We used diagnostic accuracy, negative predictive value (NPV), and negative likelihood ratio, stratified by CD4 count, to evaluate screening for culture-positive TB.ResultsAmong 675 HIV-infected adults with median CD4 of 213/mm3 (interquartile range 85-360/mm3), 123 (18%) had culture-confirmed pulmonary TB. The WHO-recommended algorithm of any TB-related symptom had a sensitivity of 77% [95% confidence interval (CI) 69-84%] and NPV of 89% (95% CI 84-92%) for identifying active pulmonary TB. Including the LAM assay improved sensitivity (83%; 95% CI 75-89%) and NPV (91%; 95% CI 86-94%), while decreasing the negative likelihood ratio (0.45 versus 0.57). Among participants with CD4 < 100/mm3, including urine LAM testing improved the negative predictive value of symptom based screening from 83% to 87%. All screening algorithms with urine LAM performed better among participants with CD4 < 100/mm3, compared to those with CD4 ≥ 100/mm3.ConclusionClinic-based urine LAM screening increased the sensitivity of symptom-based screening by 6% among ART-naïve HIV-infected adults in a TB-endemic setting, thereby providing marginal benefit.

【 授权许可】

CC BY   
© The Author(s). 2016