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. 2020 Dec 23;8(2):ofaa639.
doi: 10.1093/ofid/ofaa639. eCollection 2021 Feb.

Urine Lipoarabinomannan Testing for All HIV Patients Hospitalized in Medical Wards Identifies a Large Proportion of Patients With Tuberculosis at Risk of Death

Helena Huerga  1 , Sekai Chenai Mathabire Rucker  2 , Mathieu Bastard  1 , James Mpunga  3 , Isabel Amoros Quiles  2 , Chimwemwe Kabaghe  4 , Laura Sannino  5 , Elisabeth Szumilin  5
Affiliations

Urine Lipoarabinomannan Testing for All HIV Patients Hospitalized in Medical Wards Identifies a Large Proportion of Patients With Tuberculosis at Risk of Death

Helena Huerga et al. Open Forum Infect Dis. .

Abstract

Background: Diagnosing tuberculosis (TB), the leading cause of death in people with HIV, remains a challenge in resource-limited countries. We assessed TB diagnosis using a strategy that included systematic urine lipoarabinomannan (LAM) testing for all HIV patients hospitalized in medical wards and 6-month mortality according to LAM results.

Methods: This prospective, observational study included adult HIV patients hospitalized in the medical wards of a public district hospital in Malawi regardless of their TB symptoms or CD4 count. Each patient had a clinical examination, and Alere Determine TB-LAM, sputum microscopy, sputum GeneXpert MTB/RIF (Xpert), chest x-ray, and CD4 count were systematically requested.

Results: Among 387 inpatients, 54% had a CD4 <200 cells/µL, 64% had presumptive TB, and 90% had ≥1 TB symptom recorded in their medical file. LAM results were available for 99.0% of patients, microscopy for 62.8%, and Xpert for 60.7%. In total, 26.1% (100/383) had LAM-positive results, 48% (48/100) of which were grades 2-4. Any TB laboratory test result was positive in 30.8% (119/387). Among patients with no Xpert result, 28.5% (43/151) were LAM-positive. Cumulative 6-month mortality was 40.1% (151/377): 50.5% (49/97) in LAM-positives and 36.2% (100/276) in LAM-negatives (P = .013). In multivariable regression analyses, LAM-positive patients had a higher risk of mortality than LAM-negatives (adjusted odds ratio, 2.5; 95% CI, 1.1-5.8; P = .037).

Conclusions: In resource-limited hospital medical wards with high TB prevalence, a diagnostic strategy including systematic urine LAM testing for all HIV patients is an easily implementable strategy that identifies a large proportion of patients with TB at risk of death.

Keywords: CD4 lymphocyte count; death; in-patients; low-income countries; point-of-care testing.

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Figures

Figure 1.
Figure 1.
Mortality at 6 months by LAM result in all patients (A), in patients with CD4 ≥200 cells/µL (B), and in patients with CD4 <200 cells/µL (C), Malawi, 2017. Abbreviation: LAM, lipoarabinomannan.
See this image and copyright information in PMC

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