Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe

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dc.contributor.authorZijenah, Lynn Sodai
dc.contributor.authorKadzirange, Gerard
dc.contributor.authorBandason, Tsitsi
dc.contributor.authorChipiti, Maria Mary
dc.contributor.authorGwambiwa, Bevel
dc.contributor.authorMakoga, Forget
dc.contributor.authorChungu, Pauline
dc.contributor.authorKaguru, Philip
dc.contributor.authorSabur, Natasha F
dc.date.accessioned2021-10-08T06:20:26Z
dc.date.available2021-10-08T06:20:26Z
dc.date.issued2015
dc.description.abstractBackgroundIn Zimbabwe, sputum smear microscopy (SSM) is the routinely used TB diagnostic tool in hospitalised HIV-infected patients. However, SSM has poor sensitivity in HIV-infected patients. We compared performance of urine lipoarabinomannan strip test (LAM) and SSM among hospitalized HIV-infected patients with suspected TB.MethodsHospitalized HIV-infected patients with suspected TB were randomized to LAM plus SSM or SSM alone groups as part of a larger multi-country parent study. Here we present a comparison of LAM versus SSM performance from the Zimbabwe study site. LAM analyses (grade 2 cut-off) were conducted using (i) a microbiological reference standard (MRS; culture positivity for M.tb and designated definite TB) and (ii) a composite reference standard (CRS; definite TB plus probable TB i.e. patients with clinical TB excluded from the culture negative group). CRS constituted the primary analysis.Results82/457 (18%) of the patients randomized to the LAM group were M.tuberculosis culture positive. Using CRS, sensitivity (%, 95 % CI) of LAM was significantly higher than SSM [49.2 (42.1-56.4) versus 29.4(23.2-36.3); p < 0.001]. Specificity and PPV were 98.1%, and 95.8%, respectively. By contrast, using MRS, LAM sensitivity was similar to SSM and specificity was significantly lower, however, the combined sensitivity of LAM and SSM was significantly higher than that of SSM alone, p = 0.009. Using CRS, LAM sensitivity (%, CI) was CD4 count dependent [60.6(50.7-69.8) at ≤50 cells/μL; 40.0(22.7-59.4) at 51-100 cells/μL, and 32.8(21.0-46.3) at >100 cells/μL. The combined sensitivity of LAM and SSM was higher than SSM alone being highest at CD4 counts <50 cells/μL [67.6(57.9-76.3); p = <0.001]. Specificity of LAM or SSM alone, or of combined LAM and SSM was >97% in all the 3 CD4 strata.ConclusionAmong hospitalized HIV-infected patients with suspected TB, the sensitivity of LAM is significantly higher than that of SSM, especially at low CD4 counts. LAM and SSM are complimentary tests for diagnosis of TB in HIV-infected patients. We recommend a combination of LAM and SSM for TB diagnosis in HIV-infected patients with low CD4 counts in HIV/TB co-endemic countries, where alternative methods are unavailable.
dc.identifier.apacitationZijenah, L. S., Kadzirange, G., Bandason, T., Chipiti, M. M., Gwambiwa, B., Makoga, F., ... Sabur, N. F. (2015). Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe. <i>BMC Infectious Diseases</i>, 16(1), 174 - 177. http://hdl.handle.net/11427/34278en_ZA
dc.identifier.chicagocitationZijenah, Lynn Sodai, Gerard Kadzirange, Tsitsi Bandason, Maria Mary Chipiti, Bevel Gwambiwa, Forget Makoga, Pauline Chungu, Philip Kaguru, and Natasha F Sabur "Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe." <i>BMC Infectious Diseases</i> 16, 1. (2015): 174 - 177. http://hdl.handle.net/11427/34278en_ZA
dc.identifier.citationZijenah, L.S., Kadzirange, G., Bandason, T., Chipiti, M.M., Gwambiwa, B., Makoga, F., Chungu, P. & Kaguru, P. et al. 2015. Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe. <i>BMC Infectious Diseases.</i> 16(1):174 - 177. http://hdl.handle.net/11427/34278en_ZA
dc.identifier.issn1471-2334
dc.identifier.ris TY - Journal Article AU - Zijenah, Lynn Sodai AU - Kadzirange, Gerard AU - Bandason, Tsitsi AU - Chipiti, Maria Mary AU - Gwambiwa, Bevel AU - Makoga, Forget AU - Chungu, Pauline AU - Kaguru, Philip AU - Sabur, Natasha F AB - BackgroundIn Zimbabwe, sputum smear microscopy (SSM) is the routinely used TB diagnostic tool in hospitalised HIV-infected patients. However, SSM has poor sensitivity in HIV-infected patients. We compared performance of urine lipoarabinomannan strip test (LAM) and SSM among hospitalized HIV-infected patients with suspected TB.MethodsHospitalized HIV-infected patients with suspected TB were randomized to LAM plus SSM or SSM alone groups as part of a larger multi-country parent study. Here we present a comparison of LAM versus SSM performance from the Zimbabwe study site. LAM analyses (grade 2 cut-off) were conducted using (i) a microbiological reference standard (MRS; culture positivity for M.tb and designated definite TB) and (ii) a composite reference standard (CRS; definite TB plus probable TB i.e. patients with clinical TB excluded from the culture negative group). CRS constituted the primary analysis.Results82/457 (18%) of the patients randomized to the LAM group were M.tuberculosis culture positive. Using CRS, sensitivity (%, 95 % CI) of LAM was significantly higher than SSM [49.2 (42.1-56.4) versus 29.4(23.2-36.3); p < 0.001]. Specificity and PPV were 98.1%, and 95.8%, respectively. By contrast, using MRS, LAM sensitivity was similar to SSM and specificity was significantly lower, however, the combined sensitivity of LAM and SSM was significantly higher than that of SSM alone, p = 0.009. Using CRS, LAM sensitivity (%, CI) was CD4 count dependent [60.6(50.7-69.8) at ≤50 cells/μL; 40.0(22.7-59.4) at 51-100 cells/μL, and 32.8(21.0-46.3) at >100 cells/μL. The combined sensitivity of LAM and SSM was higher than SSM alone being highest at CD4 counts <50 cells/μL [67.6(57.9-76.3); p = <0.001]. Specificity of LAM or SSM alone, or of combined LAM and SSM was >97% in all the 3 CD4 strata.ConclusionAmong hospitalized HIV-infected patients with suspected TB, the sensitivity of LAM is significantly higher than that of SSM, especially at low CD4 counts. LAM and SSM are complimentary tests for diagnosis of TB in HIV-infected patients. We recommend a combination of LAM and SSM for TB diagnosis in HIV-infected patients with low CD4 counts in HIV/TB co-endemic countries, where alternative methods are unavailable. DA - 2015 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PY - 2015 SM - 1471-2334 T1 - Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe TI - Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe UR - http://hdl.handle.net/11427/34278 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34278
dc.identifier.vancouvercitationZijenah LS, Kadzirange G, Bandason T, Chipiti MM, Gwambiwa B, Makoga F, et al. Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe. BMC Infectious Diseases. 2015;16(1):174 - 177. http://hdl.handle.net/11427/34278.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.journalvolume16
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12879-016-1339-z
dc.subject.otherAdult
dc.subject.otherFemale
dc.subject.otherHIV Infections
dc.subject.otherHumans
dc.subject.otherLipopolysaccharides
dc.subject.otherMale
dc.subject.otherMicroscopy
dc.subject.otherMiddle Aged
dc.subject.otherMycobacterium tuberculosis
dc.subject.otherSensitivity and Specificity
dc.subject.otherSputum
dc.subject.otherTuberculosis
dc.subject.otherZimbabwe
dc.subject.otherLipopolysaccharides
dc.subject.otherlipoarabinomannan
dc.titleComparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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