Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection

 

Show simple item record

dc.contributor.author Gina, Phindile
dc.contributor.author Randall, Philippa J
dc.contributor.author Muchinga, Tapuwa E
dc.contributor.author Pooran, Anil
dc.contributor.author Meldau, Richard
dc.contributor.author Peter, Jonny G
dc.contributor.author Dheda, Keertan
dc.date.accessioned 2017-06-23T08:52:36Z
dc.date.available 2017-06-23T08:52:36Z
dc.date.issued 2017-05-12
dc.identifier.citation Gina, P., Randall, P. J., Muchinga, T. E., Pooran, A., Meldau, R., Peter, J. G., & Dheda, K. (2017). Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection. BMC infectious diseases, 17(1), 339.
dc.identifier.uri http://dx.doi.org/10.1186/s12879-017-2313-0
dc.identifier.uri http://hdl.handle.net/11427/24614
dc.description.abstract Background: Urine LAM testing has been approved by the WHO for use in hospitalised patients with advanced immunosuppression. However, sensitivity remains suboptimal. We therefore examined the incremental diagnostic sensitivity of early morning urine (EMU) versus random urine sampling using the Determine® lateral flow lipoarabinomannan assay (LF-LAM) in HIV-TB co-infected patients. Methods: Consenting HIV-infected inpatients, screened as part of a larger prospective randomized controlled trial, that were treated for TB, and could donate matched random and EMU samples were included. Thus paired sample were collected from the same patient, LF-LAM was graded using the pre-January 2014, with grade 1 and 2 manufacturer-designated cut-points (the latter designated grade 1 after January 2014). Single sputum Xpert-MTB/ RIF and/or TB culture positivity served as the reference standard (definite TB). Those treated for TB but not meeting this standard were designated probable TB. Results: 123 HIV-infected patients commenced anti-TB treatment and provided matched random and EMU samples. 33% (41/123) and 67% (82/123) had definite and probable TB, respectively. Amongst those with definite TB LF-LAM sensitivity (95%CI), using the grade 2 cut-point, increased from 12% (5–24; 5/43) to 39% (26–54; 16/41) with random versus EMU, respectively (p = 0.005). Similarly, amongst probable TB, LF-LAM sensitivity increased from 10% (5–17; 8/83) to 24% (16–34; 20/82) (p = 0.001). LF-LAM specificity was not determined. Conclusion: This proof of concept study indicates that EMU could improve the sensitivity of LF-LAM in hospitalised TB-HIV co-infected patients. These data have implications for clinical practice.
dc.language.iso en
dc.publisher BioMed Central
dc.source BMC Infectious Diseases
dc.source.uri https://bmcinfectdis.biomedcentral.com/
dc.subject.other TB HIV co-infection
dc.subject.other Determine® lateral flow lipoarabinomannan assay (LF-LAM)
dc.subject.other Early morning urine (EMU)
dc.title Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection
dc.type Journal Article
dc.type Journal Article en_ZA
dc.date.updated 2017-05-14T03:25:47Z
dc.rights.holder The Author(s).
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Pulmonology en_ZA
uct.type.filetype Text
uct.type.filetype Image


Files in this item

This item appears in the following Collection(s)

Show simple item record