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. |
| بيانات النشر: |
BioMed Central |
| سنة النشر: |
2016 |
| مصطلحات موضوعية: |
Tuberculosis, HIV/AIDS, Lipoarabinomannan (LAM), Urine, Diagnostic screening, South Africa, demo, envir |
| 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. ; Version of Record |
| نوع الوثيقة: |
article in journal/newspaper |
| اللغة: |
English |
| العلاقة: |
http://nrs.harvard.edu/urn-3:HUL.InstRepos:29626215Test |
| الإتاحة: |
http://nrs.harvard.edu/urn-3:HUL.InstRepos:29626215Test |
| حقوق: |
undefined |
| رقم الانضمام: |
edsbas.A46CB1BB |
| قاعدة البيانات: |
BASE |
