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http://ir.mu.ac.ke:8080/jspui/handle/123456789/9073
Title: | Urine Lipoarabinomannan Testing in Adults With Advanced Human Immunodeficiency Virus in a Trial of Empiric Tuberculosis Therapy |
Authors: | Matoga, Mitch M. Bisson, Gregory P. Gupta, Amita Miyahara, Sachiko Sun, Xin Fry, Carrie Manabe, Yukari C. Kumwenda, Johnstone Cecilia, Kanyama Nyirenda, Mulinda Ngongondo, McNeil Mbewe, Abineli Lagat, David Wallis, Carole Mugerwa, Henry Hosseinipour, Mina C. |
Keywords: | Urine LAM Tuberculosis Advanced HIV disease Empiric TB therapy Isoniazid preventive therapy |
Issue Date: | 26-Feb-2021 |
Publisher: | OXFORD |
Abstract: | Background. The urine lipoarabinomannan (LAM) antigen test is a tuberculosis (TB) diagnostic test with highest sensitivity in individuals with advanced human immunodeficiency virus (HIV). Its role in TB diagnostic algorithms for HIV-positive outpatients remains unclear. Methods. The AIDS Clinical Trials Group (ACTG) A5274 trial demonstrated that empiric TB therapy did not improve 24-week survival compared to isoniazid preventive therapy (IPT) in TB screen–negative HIV-positive adults initiating antiretroviral therapy with CD4 counts <50 cells/μL. Retrospective LAM testing was performed on stored urine obtained at baseline. We determined the proportion of LAM-positive participants and conducted modified intent-to-treat analysis excluding LAM-positive participants to determine the effect on 24-week survival, TB incidence, and time to TB using Kaplan-Meier method. Results. A5274 enrolled 850 participants; 53% were male and the median CD4 count was 18 (interquartile range, 9–32) cells/ μL. Of the 850, 566 (67%) had LAM testing (283 per arm); 28 (5%) were positive (21 [7%] and 7 [2%] in the empiric and IPT arms, respectively). Of those LAM-positive, 1 participant in each arm died and 5 of 21 and 0 of 7 in empiric and IPT arms, respectively, developed TB. After excluding these 28 cases, there were 19 and 21 deaths in the empiric and IPT arms, respectively (P = .88). TB incidence remained higher (4.6% vs 2%, P = .04) and time to TB remained faster in the empiric arm (P = .04). Conclusions. Among outpatients with advanced HIV who screened negative for TB by clinical symptoms, microscopy, and Xpert testing, LAM testing identified an additional 5% of individuals with TB. Positive LAM results did not change mortality or TB incidence. |
URI: | http://ir.mu.ac.ke:8080/jspui/handle/123456789/9073 |
Appears in Collections: | School of Medicine |
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s41598-021-83302-0.pdf | 1.32 MB | Adobe PDF | View/Open |
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