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

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dc.contributor.authorGina, Phindile
dc.contributor.authorRandall, Philippa J
dc.contributor.authorMuchinga, Tapuwa E
dc.contributor.authorPooran, Anil
dc.contributor.authorMeldau, Richard
dc.contributor.authorPeter, Jonny G
dc.contributor.authorSabur, Natasha F
dc.date.accessioned2021-10-08T06:20:30Z
dc.date.available2021-10-08T06:20:30Z
dc.date.issued2017
dc.description.abstractBACKGROUND: 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.apacitationGina, P., Randall, P. J., Muchinga, T. E., Pooran, A., Meldau, R., Peter, J. G., & Sabur, N. F. (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>, 17(1), 174 - 177. http://hdl.handle.net/11427/34292en_ZA
dc.identifier.chicagocitationGina, Phindile, Philippa J Randall, Tapuwa E Muchinga, Anil Pooran, Richard Meldau, Jonny G Peter, and Natasha F Sabur "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> 17, 1. (2017): 174 - 177. http://hdl.handle.net/11427/34292en_ZA
dc.identifier.citationGina, P., Randall, P.J., Muchinga, T.E., Pooran, A., Meldau, R., Peter, J.G. & Sabur, N.F. 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> 17(1):174 - 177. http://hdl.handle.net/11427/34292en_ZA
dc.identifier.issn1471-2334
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 - Sabur, Natasha F 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 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PY - 2017 SM - 1471-2334 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/11427/34292 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34292
dc.identifier.vancouvercitationGina 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;17(1):174 - 177. http://hdl.handle.net/11427/34292.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Infectious Diseases
dc.source.journalissue1
dc.source.journalvolume17
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12879-017-2313-0
dc.subject.otherDetermine® lateral flow lipoarabinomannan assay (LF-LAM)
dc.subject.otherEarly morning urine (EMU)
dc.subject.otherTB HIV co-infection
dc.subject.otherAIDS-Related Opportunistic Infections
dc.subject.otherAdult
dc.subject.otherFemale
dc.subject.otherHIV Infections
dc.subject.otherHumans
dc.subject.otherLipopolysaccharides
dc.subject.otherMale
dc.subject.otherProspective Studies
dc.subject.otherSensitivity and Specificity
dc.subject.otherSputum
dc.subject.otherTuberculosis
dc.subject.otherUrinalysis
dc.subject.otherUrine Specimen Collection
dc.subject.otherLipopolysaccharides
dc.titleEarly morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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