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. 2017 Aug 14;4(3):ofx167.
doi: 10.1093/ofid/ofx167. eCollection 2017 Summer.

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

Paul K Drain  1   2   3   4 , Elena Losina  5   6 , Sharon M Coleman  6 , Janet Giddy  7 , Douglas Ross  8 , Jeffrey N Katz  5 , Kenneth A Freedberg  9   6 , Ingrid V Bassett  9
Affiliations

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

Paul K Drain et al. Open Forum Infect Dis. .

Abstract

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.

Keywords: HIV/AIDS; South Africa; lipoarabinomannan (LAM); tuberculosis; urine.

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Figures

Figure 1.
Figure 1.
(A) Survival by tuberculosis (TB) category at baseline assessment for antiretroviral therapy (ART)-naive human immunodeficiency virus (HIV)-infected participants. (B) Survival by TB category at baseline assessment for ART-naive HIV-infected participants with CD4 ≤100 cells/mm3. LAM, lipoarabinomannan.
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