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Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India

BACKGROUND: People with Advanced HIV Disease (AHD) are at higher risk of TB coinfection and mortality. However, there are challenges in TB diagnosis with the currently recommended diagnostic tools. WHO recommends lateral flow urine lipoarabinomannan (LF-LAM) assay to assist TB diagnosis among AHD pa...

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Autores principales: Acharya, Shrikala, Deshpande, Prashant, Asirvatham, Edwin Sam, Palkar, Amol, Sarman, Charishma Jones, Laxmeshwar, Chinmay, Setia, Maninder Singh, Rathod, Dhirubhai, Koli, Sagar, Dale, Jayesh, Yeldandi, Vijay, Allam, Ramesh, Agarwal, Reshu, Verma, Sanjeev, Upadhyaya, Sunita, Nyendak, Melissa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473623/
https://www.ncbi.nlm.nih.gov/pubmed/36103506
http://dx.doi.org/10.1371/journal.pone.0273970
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author Acharya, Shrikala
Deshpande, Prashant
Asirvatham, Edwin Sam
Palkar, Amol
Sarman, Charishma Jones
Laxmeshwar, Chinmay
Setia, Maninder Singh
Rathod, Dhirubhai
Koli, Sagar
Dale, Jayesh
Yeldandi, Vijay
Allam, Ramesh
Agarwal, Reshu
Verma, Sanjeev
Upadhyaya, Sunita
Nyendak, Melissa
author_facet Acharya, Shrikala
Deshpande, Prashant
Asirvatham, Edwin Sam
Palkar, Amol
Sarman, Charishma Jones
Laxmeshwar, Chinmay
Setia, Maninder Singh
Rathod, Dhirubhai
Koli, Sagar
Dale, Jayesh
Yeldandi, Vijay
Allam, Ramesh
Agarwal, Reshu
Verma, Sanjeev
Upadhyaya, Sunita
Nyendak, Melissa
author_sort Acharya, Shrikala
collection PubMed
description BACKGROUND: People with Advanced HIV Disease (AHD) are at higher risk of TB coinfection and mortality. However, there are challenges in TB diagnosis with the currently recommended diagnostic tools. WHO recommends lateral flow urine lipoarabinomannan (LF-LAM) assay to assist TB diagnosis among AHD patients. We assessed the utility and acceptability of using urine LF-LAM assay for TB diagnosis among patients at public Antiretroviral Therapy (ART) Centres in Mumbai. METHODS: The cross-sectional study was conducted among adult AHD patients accessing care from 17 ART centres during November,2020-June, 2021. Urine LF-LAM was offered as routine care for eligible patients in combination with standard diagnostic tests. We calculated the proportion of positive LF-LAM results by CD4 categories and TB symptoms and performed multivariable logistic regression to determine the factors associated with LF-LAM positivity. RESULTS: Among 2,390 patients, the majority (74.5%) had CD4 between 101–200 cells/mm(3). The mean age was 43.7 years (SD:10.6), 68.6% were male, 8.4% had TB symptoms and 88.0% were on ART. The overall proportion of patients with urine LF-LAM positive results was 6.4%. Among PLHIV with CD4≤100 cells/mm(3), the positivity was 43.0% and 7.7% in symptomatic and asymptomatic patients, respectively. Among PLHIV with a CD4>100 cells/mm(3), the positivity was 26.7% and 2.7% in symptomatic and asymptomatic patients respectively. Urine LF-LAM positivity was higher among inpatients, ART naïve, patients on treatment for <6 months, symptomatic and in WHO clinical stage III/IV of HIV disease as compared to the reference categories. We detected an additional 131 TB cases with urine LF-LAM in combination with the standard diagnostic tests. CONCLUSION: The study demonstrated the utility of urine LF-LAM for TB diagnosis among AHD patients and the simple, user-friendly test was acceptable as part of routine care. Inclusion of urine LF-LAM test in the current diagnostic algorithm may facilitate early TB diagnosis among AHD patients.
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spelling pubmed-94736232022-09-15 Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India Acharya, Shrikala Deshpande, Prashant Asirvatham, Edwin Sam Palkar, Amol Sarman, Charishma Jones Laxmeshwar, Chinmay Setia, Maninder Singh Rathod, Dhirubhai Koli, Sagar Dale, Jayesh Yeldandi, Vijay Allam, Ramesh Agarwal, Reshu Verma, Sanjeev Upadhyaya, Sunita Nyendak, Melissa PLoS One Research Article BACKGROUND: People with Advanced HIV Disease (AHD) are at higher risk of TB coinfection and mortality. However, there are challenges in TB diagnosis with the currently recommended diagnostic tools. WHO recommends lateral flow urine lipoarabinomannan (LF-LAM) assay to assist TB diagnosis among AHD patients. We assessed the utility and acceptability of using urine LF-LAM assay for TB diagnosis among patients at public Antiretroviral Therapy (ART) Centres in Mumbai. METHODS: The cross-sectional study was conducted among adult AHD patients accessing care from 17 ART centres during November,2020-June, 2021. Urine LF-LAM was offered as routine care for eligible patients in combination with standard diagnostic tests. We calculated the proportion of positive LF-LAM results by CD4 categories and TB symptoms and performed multivariable logistic regression to determine the factors associated with LF-LAM positivity. RESULTS: Among 2,390 patients, the majority (74.5%) had CD4 between 101–200 cells/mm(3). The mean age was 43.7 years (SD:10.6), 68.6% were male, 8.4% had TB symptoms and 88.0% were on ART. The overall proportion of patients with urine LF-LAM positive results was 6.4%. Among PLHIV with CD4≤100 cells/mm(3), the positivity was 43.0% and 7.7% in symptomatic and asymptomatic patients, respectively. Among PLHIV with a CD4>100 cells/mm(3), the positivity was 26.7% and 2.7% in symptomatic and asymptomatic patients respectively. Urine LF-LAM positivity was higher among inpatients, ART naïve, patients on treatment for <6 months, symptomatic and in WHO clinical stage III/IV of HIV disease as compared to the reference categories. We detected an additional 131 TB cases with urine LF-LAM in combination with the standard diagnostic tests. CONCLUSION: The study demonstrated the utility of urine LF-LAM for TB diagnosis among AHD patients and the simple, user-friendly test was acceptable as part of routine care. Inclusion of urine LF-LAM test in the current diagnostic algorithm may facilitate early TB diagnosis among AHD patients. Public Library of Science 2022-09-14 /pmc/articles/PMC9473623/ /pubmed/36103506 http://dx.doi.org/10.1371/journal.pone.0273970 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Acharya, Shrikala
Deshpande, Prashant
Asirvatham, Edwin Sam
Palkar, Amol
Sarman, Charishma Jones
Laxmeshwar, Chinmay
Setia, Maninder Singh
Rathod, Dhirubhai
Koli, Sagar
Dale, Jayesh
Yeldandi, Vijay
Allam, Ramesh
Agarwal, Reshu
Verma, Sanjeev
Upadhyaya, Sunita
Nyendak, Melissa
Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India
title Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India
title_full Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India
title_fullStr Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India
title_full_unstemmed Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India
title_short Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India
title_sort utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced hiv disease at antiretroviral therapy centres in mumbai, india
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473623/
https://www.ncbi.nlm.nih.gov/pubmed/36103506
http://dx.doi.org/10.1371/journal.pone.0273970
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