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Multicenter Study
. 2018 Nov 1;22(11):1366-1373.
doi: 10.5588/ijtld.18.0099.

Urinary LAM grade, culture positivity, and mortality among HIV-infected South African out-patients

R W Kubiak  1 , J T Herbeck  2 , S M Coleman  3 , D Ross  4 , K Freedberg  5 , I V Bassett  6 , P K Drain  7
Affiliations
Multicenter Study

Urinary LAM grade, culture positivity, and mortality among HIV-infected South African out-patients

R W Kubiak et al. Int J Tuberc Lung Dis. .

Abstract

Setting: Four ambulatory clinics in Durban, South Africa.

Objective: To test the relationships of patient characteristics, time to mycobacterial culture positivity, and mortality with urinary lipoarabinomannan (LAM) grade category.

Design: Newly diagnosed human immunodeficiency virus (HIV) infected adults were screened for tuberculosis (TB) using sputum culture, tested for urinary LAM, and followed for up to 12 months. We performed multivariable ordinal logistic regression of risk factors for low (1 or 2) or high (3, 4, or 5) LAM grade. We used adjusted Cox regression models to determine the hazard ratios of time to culture positivity and death.

Results: Among 683 HIV-infected adults, median CD4 count was 215 cells/mm³ (interquartile range 86-361 cells/mm³), 17% had culture-confirmed TB, and 11% died during follow-up. Smoking, tachycardia (pulse > 100 beats/minute), CD4 count < 100 cells/mm³, and TB culture positivity were each associated with higher LAM grade. In multivariate models, a high urine LAM grade was associated with four-fold increased hazard of culture positivity (P = 0.001) and two-fold increased hazard of mortality (P = 0.02). Among patients treated for TB, these associations were no longer statistically significant.

Conclusion: In this population, a higher urine LAM grade was associated with shorter time to culture positivity and mortality; however, these associations were not present for those starting anti-tuberculosis treatment.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Time to death or censorship of LAM-positive (red) and LAM-negative (blue) HIV-infected adults newly diagnosed in an outpatient setting (n=679)
Figure 2a
Figure 2a
Time to death or censorship by urine LAM grade category among HIV-infected adults newly diagnosed in an outpatient setting (n=673)
Figure 2b
Figure 2b
Time to tuberculosis MGIT culture positivity by urine LAM grade category among newly diagnosed HIV-infected adults (n=591)
See this image and copyright information in PMC

References

    1. 2017 Global Tuberculosis Report. Geneva: World Health Organization; 2017.
    1. Implementing the End TB Strategy: The Essentials. Geneva, Switzerland: World Health Organization; 2015.
    1. The End TB Strategy. Geneva, Switzerland: World Health Organization; 2014.
    1. Definitions and reporting framework for tuberculosis - 2013 revision (updated December 2014) Geneva: World Health Organization;
    1. Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings. Geneva: World Health Organization; 2011.

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