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Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis

التفاصيل البيبلوغرافية
العنوان: Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis
المؤلفون: Drain, Paul K., Losina, Elena, Coleman, Sharon M., Giddy, Janet, Ross, Douglas, Katz, Jeffrey N., Bassett, Ingrid V.
المصدر: Drain, Paul K., Elena Losina, Sharon M. Coleman, Janet Giddy, Douglas Ross, Jeffrey N. Katz, and Ingrid V. Bassett. 2016. “Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis.” BMC Pulmonary Medicine 16 (1): 147. doi:10.1186/s12890-016-0316-z. http://dx.doi.org/10.1186/s12890-016-0316-zTest.
بيانات النشر: BioMed Central, 2016.
سنة النشر: 2016
المجموعة: HMS Scholarly Articles
SPH Scholarly Articles
مصطلحات موضوعية: Tuberculosis, HIV/AIDS, Lipoarabinomannan (LAM), Urine, Diagnostic screening, South Africa
الوصف: Background: World Health Organization (WHO) recommends tuberculosis (TB) screening at HIV diagnosis. We evaluated the inclusion of rapid urine lipoarabinomannan (LAM) testing in TB screening algorithms. Methods: We enrolled ART-naïve adults who screened HIV-infected in KwaZulu-Natal, assessed TB-related symptoms (cough, fever, night sweats, weight loss), and obtained sputum specimens for mycobacterial culture. Trained nurses performed clinic-based urine LAM testing using a rapid assay. We used diagnostic accuracy, negative predictive value (NPV), and negative likelihood ratio, stratified by CD4 count, to evaluate screening for culture-positive TB. Results: Among 675 HIV-infected adults with median CD4 of 213/mm3 (interquartile range 85-360/mm3), 123 (18%) had culture-confirmed pulmonary TB. The WHO-recommended algorithm of any TB-related symptom had a sensitivity of 77% [95% confidence interval (CI) 69-84%] and NPV of 89% (95% CI 84-92%) for identifying active pulmonary TB. Including the LAM assay improved sensitivity (83%; 95% CI 75-89%) and NPV (91%; 95% CI 86-94%), while decreasing the negative likelihood ratio (0.45 versus 0.57). Among participants with CD4 < 100/mm3, including urine LAM testing improved the negative predictive value of symptom based screening from 83% to 87%. All screening algorithms with urine LAM performed better among participants with CD4 < 100/mm3, compared to those with CD4 ≥ 100/mm3. Conclusion: Clinic-based urine LAM screening increased the sensitivity of symptom-based screening by 6% among ART-naïve HIV-infected adults in a TB-endemic setting, thereby providing marginal benefit.
نوع الوثيقة: Journal Article
اللغة: English
تدمد: 1471-2466
العلاقة: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109839/pdfTest/; BMC Pulmonary Medicine
DOI: 10.1186/s12890-016-0316-z
الوصول الحر: http://nrs.harvard.edu/urn-3:HUL.InstRepos:29626215Test
حقوق: open
URL: http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAATest
رقم الانضمام: edshld.1.29626215
قاعدة البيانات: Digital Access to Scholarship at Harvard (DASH)
الوصف
تدمد:14712466
DOI:10.1186/s12890-016-0316-z