Sensitivity of the lateral flow urine lipoarabinomannan assay in ambulant adults with advanced HIV disease: Data from the TB Fast Track study

Mpho Tlali, Katherine L. Fielding, Aaron S. Karat, Christopher J. Hoffmann, Tshifhiwa Muravha, Alison D. Grant, Salome Charalambous

Research output: Contribution to journalArticlepeer-review

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. Methods: We 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). Results: Of 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). Conclusions: When 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.

Original languageEnglish (US)
Pages (from-to)556-560
Number of pages5
JournalTransactions of the Royal Society of Tropical Medicine and Hygiene
Volume114
Issue number8
DOIs
StatePublished - Aug 1 2020

Keywords

  • HIV
  • South Africa
  • TB
  • TB diagnostic tests
  • algorithms
  • lipoarabinomannan

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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