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DC Field | Value | Language |
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dc.contributor.author | Matoga, Mitch M. | - |
dc.contributor.author | Bisson, Gregory P. | - |
dc.contributor.author | Gupta, Amita | - |
dc.contributor.author | Miyahara, Sachiko | - |
dc.contributor.author | Sun, Xin | - |
dc.contributor.author | Fry, Carrie | - |
dc.contributor.author | Manabe, Yukari C. | - |
dc.contributor.author | Kumwenda, Johnstone | - |
dc.contributor.author | Cecilia, Kanyama | - |
dc.contributor.author | Nyirenda, Mulinda | - |
dc.contributor.author | Ngongondo, McNeil | - |
dc.contributor.author | Mbewe, Abineli | - |
dc.contributor.author | Lagat, David | - |
dc.contributor.author | Wallis, Carole | - |
dc.contributor.author | Mugerwa, Henry | - |
dc.contributor.author | Hosseinipour, Mina C. | - |
dc.date.accessioned | 2024-05-09T08:14:41Z | - |
dc.date.available | 2024-05-09T08:14:41Z | - |
dc.date.issued | 2021-02-26 | - |
dc.identifier.uri | http://ir.mu.ac.ke:8080/jspui/handle/123456789/9073 | - |
dc.description.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. | en_US |
dc.description.sponsorship | U54EB007958 | en_US |
dc.language.iso | en | en_US |
dc.publisher | OXFORD | en_US |
dc.subject | Urine LAM | en_US |
dc.subject | Tuberculosis | en_US |
dc.subject | Advanced HIV disease | en_US |
dc.subject | Empiric TB therapy | en_US |
dc.subject | Isoniazid preventive therapy | en_US |
dc.title | Urine Lipoarabinomannan Testing in Adults With Advanced Human Immunodeficiency Virus in a Trial of Empiric Tuberculosis Therapy | en_US |
dc.type | Article | en_US |
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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