Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection
| 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.date.updated | 2017-05-14T03:25:47Z | |
| 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.identifier.apacitation | 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. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/24614 | en_ZA |
| dc.identifier.chicagocitation | Gina, Phindile, Philippa J Randall, Tapuwa E Muchinga, Anil Pooran, Richard Meldau, Jonny G Peter, and Keertan Dheda "Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection." <i>BMC Infectious Diseases</i> (2017) http://hdl.handle.net/11427/24614 | en_ZA |
| 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.ris | TY - Journal Article AU - Gina, Phindile AU - Randall, Philippa J AU - Muchinga, Tapuwa E AU - Pooran, Anil AU - Meldau, Richard AU - Peter, Jonny G AU - Dheda, Keertan AB - 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. DA - 2017-05-12 DB - OpenUCT DO - 10.1186/s12879-017-2313-0 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection TI - Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection UR - http://hdl.handle.net/11427/24614 ER - | en_ZA |
| dc.identifier.uri | http://dx.doi.org/10.1186/s12879-017-2313-0 | |
| dc.identifier.uri | http://hdl.handle.net/11427/24614 | |
| dc.identifier.vancouvercitation | Gina P, Randall PJ, Muchinga TE, Pooran A, Meldau R, Peter JG, et al. Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection. BMC Infectious Diseases. 2017; http://hdl.handle.net/11427/24614. | en_ZA |
| dc.language.iso | en | |
| dc.publisher | BioMed Central | |
| dc.publisher.department | Division of Pulmonology | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights.holder | The Author(s). | |
| 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 | |
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |