Diagnosing tuberculosis in hospitalized HIV-infected individuals who cannot produce sputum: is urine lipoarabinomannan testing the answer?

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dc.contributor.authorSabur, Natasha F
dc.contributor.authorEsmail, Aliasgar
dc.contributor.authorBrar, Mantaj S
dc.contributor.authorDheda, Keertan
dc.date.accessioned2021-10-08T06:20:30Z
dc.date.available2021-10-08T06:20:30Z
dc.date.issued2017
dc.description.abstractAbstract Background Up to one third of HIV-infected individuals with suspected TB are sputum-scarce. The Alere Determine™ TB LAM Ag lateral flow strip test can be used to diagnose TB in HIV-infected patients with advanced immunosuppression. However, how urine LAM testing should be incorporated into testing algorithms and in the context of specific patient sub-groups remains unclear. Methods This study represents a post hoc sub-group analysis of data from a randomized multi-center parent study. The study population consisted of hospitalized HIV-infected patients with suspected TB who were unable to produce sputum and who underwent urine LAM testing. The diagnostic utility of urine LAM for TB in this group was compared to the performance of urine LAM in patients who did produce a sputum sample in the parent study. Results There were a total of 187 and 2341 patients in the sputum-scarce and sputum-producing cohorts, respectively. 80 of the sputum-scarce patients underwent testing with urine LAM. In comparison to those who did produce sputum, sputum-scarce patients had a younger age, a lower Karnofsky performance score, and a lower weight and BMI at admission. A greater proportion of sputum-scarce patients were urine LAM positive, compared to those who were able to produce sputum (31% vs. 21%, p = 0.04). A higher proportion of sputum-scarce patients died within 8 weeks of admission (32% vs. 24%, p = 0.013). We inferred that 19% of HIV-infected sputum-scarce patients suspected of TB were diagnosed with tuberculosis by urine LAM testing, with an estimated positive predictive value of 63% (95% CI 43–82%). Conclusions Urine LAM testing can effectively identify tuberculosis in HIV-infected patients who are at a higher risk of mortality yet are unable to generate a sputum sample for diagnostic testing. Our findings support the use of urine LAM testing in sputum-scarce hospitalized HIV-infected patients, and its incorporation into diagnostic algorithms for this patient population.
dc.identifier.apacitationSabur, N. F., Esmail, A., Brar, M. S., & Dheda, K. (2017). Diagnosing tuberculosis in hospitalized HIV-infected individuals who cannot produce sputum: is urine lipoarabinomannan testing the answer?. <i>BMC Infectious Diseases</i>, 17(1), 174 - 177. http://hdl.handle.net/11427/34291en_ZA
dc.identifier.chicagocitationSabur, Natasha F, Aliasgar Esmail, Mantaj S Brar, and Keertan Dheda "Diagnosing tuberculosis in hospitalized HIV-infected individuals who cannot produce sputum: is urine lipoarabinomannan testing the answer?." <i>BMC Infectious Diseases</i> 17, 1. (2017): 174 - 177. http://hdl.handle.net/11427/34291en_ZA
dc.identifier.citationSabur, N.F., Esmail, A., Brar, M.S. & Dheda, K. 2017. Diagnosing tuberculosis in hospitalized HIV-infected individuals who cannot produce sputum: is urine lipoarabinomannan testing the answer?. <i>BMC Infectious Diseases.</i> 17(1):174 - 177. http://hdl.handle.net/11427/34291en_ZA
dc.identifier.issn1471-2334
dc.identifier.ris TY - Journal Article AU - Sabur, Natasha F AU - Esmail, Aliasgar AU - Brar, Mantaj S AU - Dheda, Keertan AB - Abstract Background Up to one third of HIV-infected individuals with suspected TB are sputum-scarce. The Alere Determine™ TB LAM Ag lateral flow strip test can be used to diagnose TB in HIV-infected patients with advanced immunosuppression. However, how urine LAM testing should be incorporated into testing algorithms and in the context of specific patient sub-groups remains unclear. Methods This study represents a post hoc sub-group analysis of data from a randomized multi-center parent study. The study population consisted of hospitalized HIV-infected patients with suspected TB who were unable to produce sputum and who underwent urine LAM testing. The diagnostic utility of urine LAM for TB in this group was compared to the performance of urine LAM in patients who did produce a sputum sample in the parent study. Results There were a total of 187 and 2341 patients in the sputum-scarce and sputum-producing cohorts, respectively. 80 of the sputum-scarce patients underwent testing with urine LAM. In comparison to those who did produce sputum, sputum-scarce patients had a younger age, a lower Karnofsky performance score, and a lower weight and BMI at admission. A greater proportion of sputum-scarce patients were urine LAM positive, compared to those who were able to produce sputum (31% vs. 21%, p = 0.04). A higher proportion of sputum-scarce patients died within 8 weeks of admission (32% vs. 24%, p = 0.013). We inferred that 19% of HIV-infected sputum-scarce patients suspected of TB were diagnosed with tuberculosis by urine LAM testing, with an estimated positive predictive value of 63% (95% CI 43–82%). Conclusions Urine LAM testing can effectively identify tuberculosis in HIV-infected patients who are at a higher risk of mortality yet are unable to generate a sputum sample for diagnostic testing. Our findings support the use of urine LAM testing in sputum-scarce hospitalized HIV-infected patients, and its incorporation into diagnostic algorithms for this patient population. 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 - Diagnosing tuberculosis in hospitalized HIV-infected individuals who cannot produce sputum: is urine lipoarabinomannan testing the answer? TI - Diagnosing tuberculosis in hospitalized HIV-infected individuals who cannot produce sputum: is urine lipoarabinomannan testing the answer? UR - http://hdl.handle.net/11427/34291 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34291
dc.identifier.vancouvercitationSabur NF, Esmail A, Brar MS, Dheda K. Diagnosing tuberculosis in hospitalized HIV-infected individuals who cannot produce sputum: is urine lipoarabinomannan testing the answer?. BMC Infectious Diseases. 2017;17(1):174 - 177. http://hdl.handle.net/11427/34291.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/s12879-017-2914-7
dc.subject.otherHIV
dc.subject.otherSputum-scarce
dc.subject.otherTuberculosis
dc.subject.otherUrine LAM
dc.subject.otherAdult
dc.subject.otherCD4 Lymphocyte Count
dc.subject.otherFemale
dc.subject.otherHIV Infections
dc.subject.otherHospitalization
dc.subject.otherHumans
dc.subject.otherLipopolysaccharides
dc.subject.otherMale
dc.subject.otherMiddle Aged
dc.subject.otherSputum
dc.subject.otherTuberculosis
dc.subject.otherLipopolysaccharides
dc.subject.otherlipoarabinomannan
dc.titleDiagnosing tuberculosis in hospitalized HIV-infected individuals who cannot produce sputum: is urine lipoarabinomannan testing the answer?
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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