PLoS Medicine (Apr 2019)

Diagnostic value of the urine lipoarabinomannan assay in HIV-positive, ambulatory patients with CD4 below 200 cells/μl in 2 low-resource settings: A prospective observational study.

  • Helena Huerga,
  • Sekai Chenai Mathabire Rucker,
  • Loide Cossa,
  • Mathieu Bastard,
  • Isabel Amoros,
  • Ivan Manhiça,
  • Kuzani Mbendera,
  • Alex Telnov,
  • Elisabeth Szumilin,
  • Elisabeth Sanchez-Padilla,
  • Lucas Molfino

DOI
https://doi.org/10.1371/journal.pmed.1002792
Journal volume & issue
Vol. 16, no. 4
p. e1002792

Abstract

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BackgroundCurrent guidelines recommend the use of the lateral flow urine lipoarabinomannan assay (LAM) in HIV-positive, ambulatory patients with signs and symptoms of tuberculosis (TB) only if they are seriously ill or have CD4 count ≤ 100 cells/μl. We assessed the diagnostic yield of including LAM in TB diagnostic algorithms in HIV-positive, ambulatory patients with CD4 Methods and findingsWe conducted a prospective observational study including HIV-positive adult patients with signs and symptoms of TB and CD4 ConclusionsLAM has diagnostic value for identifying TB in HIV-positive patients with signs and symptoms of TB and advanced immunodeficiency, including those with a CD4 count of 100-199 cells/μl. In this study, the use of LAM enabled the diagnosis of TB in half of the patients with confirmed TB disease; without LAM, these patients would have been missed. The rapid identification and treatment of TB enabled by LAM may decrease overall mortality risk for these patients.