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. 2023 Sep 13:16:2632010X231198831.
doi: 10.1177/2632010X231198831. eCollection 2023 Jan-Dec.

High Positivity Rate of Urinary Mycobacterium tuberculosis Antigens Cocktail (ESAT-6, CFP-10, and MPT-64) in Active Tuberculosis Patients With and Without Human Immunodeficiency Virus Infection: A Cross-Sectional Study

Dewi Kartika Turbawaty  1 , Novie Rahmawati Surdjaja  1 , Agnes Rengga Indrati  1 , Leni Lismayanti  1 , Verina Logito  1
Affiliations

High Positivity Rate of Urinary Mycobacterium tuberculosis Antigens Cocktail (ESAT-6, CFP-10, and MPT-64) in Active Tuberculosis Patients With and Without Human Immunodeficiency Virus Infection: A Cross-Sectional Study

Dewi Kartika Turbawaty et al. Clin Pathol. .

Abstract

Introduction: Human immunodeficiency virus (HIV) infection is a risk factor for the occurrence of a large of Mycobacterium tuberculosis (Mtb) antigen load in the body. The antigens cocktail namely early secretory antigenic target protein 6-kDa (ESAT-6), Culture filtrate protein 10 kDa (CFP-10), and Mycobacterium tuberculosis protein 64 (MPT-64) are secreted by Mtb during replication, hence, their concentration increase in patients with active Tuberculosis (TB). This increased levels facilitates their entry into the systemic circulation, followed by secretion by the glomerulus into the urine. The aim of this study was to determine the positivity rate of the urinary Mtb antigens cocktail between TB patients with and without HIV infection.

Methods: This is an observational descriptive comparative study conducted with a cross-sectional design. Random urine samples were collected from patients diagnosed with active TB in Dr. Hasan Sadikin Bandung Hospital in 2021. The subjects were divided into 2 groups, TB-HIV group and TB without HIV group. The samples were tested using the quantitative immunochromatography method.

Result: Sixty active TB patients consisting of TB patients with HIV infection (n = 30) and TB patients without HIV infection (n = 30). The positivity in the urinary Mtb antigens cocktail was 93.3% for TB-HIV group and 100% for TB without HIV group (P = .492). The median concentration of urinary Mtb antigens cocktail in TB patients without HIV infection was higher than that of TB patients with HIV infection (137.73 ng/mL vs 96.69 ng/mL, respectively; P = .001).

Conclusion: There was no significant difference in the positivity rate, meanwhile, there was a significant difference in concentration of the urinary Mtb antigens cocktail between active TB patients with and without HIV infection. Interestingly, this urinary Mtb antigens cocktail can be found in both groups without being affected by the patient's immune condition, thus becoming a test to assist diagnose active TB.

Keywords: CFP-10; ESAT-6; HIV; MPT-64; TB; urinary Mtb antigens cocktail.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dewi Kartika Turbawaty is an academic author, a clinical pathologist, and the Head of Clinical Pathology, staff of Microbiology and Biomolecular Department, Faculty of Medicine Padjadjaran University, Dr. Hasan Sadikin General Hospital. Novie Rahmawati Surdjaja is a clinical pathologist. Agnes Rengga Indrati is an academic author, a clinical pathologist, and staff of the Immunoserology Department, Faculty of Medicine Padjadjaran University, Dr. Hasan Sadikin General Hospital. Leni Lismayanti is an academic author, a clinical pathologist, and staff of the Hematology Department, Faculty of Medicine Padjadjaran University, Dr. Hasan Sadikin General Hospital. Verina Logito is an academic author, a clinical pathologist, staff of Immunoserology Department, Faculty of Medicine Padjadjaran University, Dr. Hasan Sadikin General Hospital. The remaining authors declare no relevant financial disclosures or conflicts of interest.

Figures

Figure 1.
Figure 1.
Study flowchart. Abbreviations: CFP-10, culture filtrate protein-10 kDa; ESAT-6, early secreted antigen-6 kDa; HIV, human immunodeficiency virus; MPT-64, Mycobacterium tuberculosis protein-64; Mtb: Mycobacterium tuberculosis; TB, tuberculosis. Description: Analysis using Fisher Exact test = 0.492, statistically significant if P < .05.
Figure 2.
Figure 2.
Urinary Mtb antigens cocktail levels in patients with TB-HIV and TB without HIV. Abbreviations: HIV, human immunodeficiency virus; TB, active pulmonary and extra-pulmonary tuberculosis. Red line, a median of Mtb antigens cocktail levels; Mann-Whitney test, statistically significant if P < .05.
Figure 3.
Figure 3.
Urinary Mtb antigens cocktail levels in patients with TB-HIV and TB without HIV versus OAT therapy. Abbreviations: HIV, human immunodeficiency virus; OAT, oral anti-tuberculosis drug; TB, active pulmonary and extra-pulmonary tuberculosis. Mann-Whitney test, statistically significant if P < .05, red line for TB-HIV, blue line for TB without HIV.
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