دورية أكاديمية
Clinic-Based Urinary Lipoarabinomannan as a Biomarker of Clinical Disease Severity and Mortality Among Antiretroviral Therapy-Naive Human Immunodeficiency Virus-Infected Adults in South Africa
| العنوان: | Clinic-Based Urinary Lipoarabinomannan as a Biomarker of Clinical Disease Severity and Mortality Among Antiretroviral Therapy-Naive Human Immunodeficiency Virus-Infected Adults in South Africa |
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| المؤلفون: | Drain, Paul K., Losina, Elena, Coleman, Sharon M, Giddy, Janet, Ross, Douglas, Katz, Jeffrey N, Freedberg, Kenneth A, Bassett, Ingrid V |
| المساهمون: | Harvard University Center for AIDS Research, National Institute of Allergy and Infectious Diseases, National Institute of Mental Health |
| المصدر: | Open Forum Infectious Diseases ; volume 4, issue 3 ; ISSN 2328-8957 |
| بيانات النشر: | Oxford University Press (OUP) |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | Infectious Diseases, Oncology |
| الوصف: | Background Urinary lipoarabinomannan (LAM) has limited sensitivity for diagnosing active human immunodeficiency virus (HIV)-associated tuberculosis (TB) disease, but LAM screening at HIV diagnosis might identify adults with more severe clinical disease or greater risk of mortality. Methods We enrolled antiretroviral therapy-naive HIV-infected adults from 4 clinics in Durban. Nurses performed urine LAM testing using a rapid assay (Determine TB LAM) graded from low (1+) to high (≥3+) intensity. Urine LAM results were not used to guide anti-TB therapy. We assessed TB-related symptoms and obtained sputum for mycobacterial smear and culture. Participants were observed for 12 months, and we used multivariable Cox proportional hazard models to determine hazard ratios for all-cause mortality. Results Among 726 HIV-infected adults with median CD4 of 205 cells/mm3 (interquartile range, 79–350 cells/mm3), 93 (13%) were LAM positive and 89 (12%) participants died during the follow-up period. In multivariable analyses, urine LAM-positive participants had a mortality hazard ratio (MHR) of 3.58 (95% confidence interval [CI], 2.20–5.81) for all-cause mortality. Among participants with mycobacterial-confirmed TB, urine LAM-positivity had a 2.91 (95% CI, 1.26–6.73) MHR for all participants and a 4.55 (95% CI, 1.71–12.1) MHR for participants with CD4 ≤100 cell/mm3. Participants with LAM-positive TB had significantly more clinical signs and symptoms of disease, compared with participants with LAM-negative TB disease. Conclusions Among HIV-infected adults, urinary LAM-positive patients had more clinical disease severity and a 3-fold increase in 12-month mortality compared with those who were LAM negative. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1093/ofid/ofx167 |
| الإتاحة: | https://doi.org/10.1093/ofid/ofx167Test http://academic.oup.com/ofid/article-pdf/4/3/ofx167/33622609/ofx167.pdfTest |
| حقوق: | http://creativecommons.org/licenses/by-nc-nd/4.0Test |
| رقم الانضمام: | edsbas.2C2FE442 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1093/ofid/ofx167 |
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