Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in HIV-positive adults

Shah, Maunank; Hanrahan, Colleen F.; Wang, Zhuo Yu; Dendukuri, Nandini; Lawn, Stephen D.; Denkinger, Claudia M.; Steingart, Karen R

doi:10.1002/14651858.cd011420.pub2

Cited by 126 publications

(136 citation statements)

References 84 publications

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“…Interestingly, a study from Shah et al . reported that combining urine LAM assay with Xpert MTB/RIF testing of urine could be an important opportunity to improve the diagnosis of active TB in HIV co‐infected patients, indicating an important use of urine as a specimen type for the diagnosis of HIV‐associated TB.…”

Section: Current Diagnostic Tests In Hiv‐associated Tbmentioning

confidence: 99%

Diagnosis of Tuberculosis in HIV Co‐infected Individuals: Current Status, Challenges and Opportunities for the Future

Méndez-Samperio¹

2017

Scand J Immunol

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Tuberculosis (TB) remains one of the most important causes of death among people co-infected with human immunodeficiency virus (HIV). The diagnosis of TB remains challenging in HIV co-infected individuals, due to a high frequency of smear-negative disease and high rates of extrapulmonary TB. Accurate, ease of use and rapid diagnosis of active TB are critical to the World Health Organization (WHO) End TB Strategy by 2050. Traditional laboratory techniques do not provide rapid and accurate results to effectively manage HIV co-infected patients. Over the last decade, molecular methods have provided significant steps in the fight against TB. However, many HIV co-infected patients do not have access to these molecular diagnostic tests. Given the costs closely related with confirming a TB diagnosis in HIV patients, an overtreatment for TB is used in this patient population. Nowadays, an estimated US $8 billion a year is required to provide TB treatment, which is very high compared with making an important strategy to improve the current diagnostic tests. This review focuses on current advances in diagnosing active TB with an emphasis on the diagnosis of HIV-associated TB. Also discussed are the main challenges that need to be overcome for improving an adequate initial diagnosis of active TB in HIV-positive patients.

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Section: Current Diagnostic Tests In Hiv‐associated Tbmentioning

confidence: 99%

Diagnosis of Tuberculosis in HIV Co‐infected Individuals: Current Status, Challenges and Opportunities for the Future

Méndez-Samperio¹

2017

Scand J Immunol

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“…A more recent Cochrane review reported that urine LAM detection by lateral‐flow assays in HIV‐infected TB patients had a median pooled sensitivity range of 29–63% (Shah et al . ). All these variable data highlight the real need for more searches for TB biomarkers and more optimization of test formats.…”

Section: Resultsmentioning

confidence: 97%

Mycothiol acetyltransferase (Rv0819) ofMycobacterium tuberculosisis a potential biomarker for direct diagnosis of tuberculosis using patient serum specimens

Zeitoun

Bahey-El-Din

Kassem

et al. 2017

Lett Appl Microbiol

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The early and accurate diagnosis of tuberculosis infection is of paramount importance for initiating treatment and avoiding clinical complications. Most current diagnostic tests have poor sensitivity and/or specificity and in many cases they are too expensive for routine diagnostic testing in resource-limited settings. In the current study, we examined a novel mycobacterial serum biomarker, namely mycothiol acetyltransferase Rv0819. The antigen was detectable in serum specimens of a significant number of tuberculosis patients. This article proves the importance of Rv0819 and paves the way towards its future use as a useful diagnostic marker for tuberculosis infection.

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“…A meta-analysis in this population reports the LAM used to diagnose TB with a pooled sensitivity of 56% (41–70) and pooled specificity 90% (81–95). Combining Xpert MTB/RIF testing of urine with urine LF-LAM improved overall TB diagnostic sensitivity 75% (61–87) and specificity of 93% (81–97) with the added advantage of Xpert MTB/RIF simultaneously detecting susceptibility to RIF [94]. Peter et al showed that POC LAM reduced mortality at 8 weeks in hospitalised patients [95].…”

Section: Who Endorsed Diagnostic Technologiesmentioning

confidence: 99%

Diagnosis of opportunistic infections

Scott

Silva

Boehme

et al. 2017

Current Opinion in HIV and AIDS

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Purpose of the review TB incidence has declined ~1.5% annually since 2000, but continued to affect 10.4 million individuals in 2015, with 1/3 remaining undiagnosed or under reported. The diagnosis of TB among those co-infected with HIV is challenging as TB remains the leading cause of death in such individuals. Accurate and rapid diagnosis of active TB will avert mortality in both adults and children, reduce transmission, and assist in timeous decisions for ART initiation. This review describes advances in diagnosing TB, especially among HIV co-infected individuals, highlights national program’s uptake, and impact on patient care. Recent Findings The TB diagnostic landscape has been transformed over the last 5 years. Molecular diagnostics such as Xpert MTB/RIF, which simultaneously detects M. tuberculosis resistance to rifampicin, has revolutionised TB control programs. WHO endorsed the use of Xpert MTB/RIF in 2010 for use in HIV/TB co-infected patients, and later in 2013 for use as the initial diagnostic test for all adults and children with signs and symptoms of pulmonary TB. Line probe assays (LPAs) are recommended for the detection of rifampicin and isoniazid resistance in sputum smear-positive specimens and mycobacterial cultures. A second-line line probe assay has been recommended for the diagnosis of extensively drug-resistant (XDR)-TB Assays such as the urine lateral flow(LF)-lipoarabinomannan(LAM), can be used at the point of care (POC) and have a niche role to supplement the diagnosis of TB in seriously ill HIV infected, hospitalized patients with low CD4<100cells/μl. Polyvalent platforms such as the m2000 (Abbott Molecular, IL, USA) and GeneXpert (Cepheid, CA, USA) offer potential for integration of HIV and TB testing services. While the Research and Development (R&D) pipeline appears to be rich at first glance, there are actually few leads for true POC tests that would allow for earlier TB diagnosis or rapid, comprehensive drug susceptibility testing, especially when considering the very high attrition rates observed between biomarker discovery and product market entry. Summary In this review, we describe diagnostic strategies specifically for HIV and TB co-infected individuals. Molecular diagnostics in particular within the past 5 years have revolutionized and “disrupted” this field. They lend themselves to integration of services with platforms capable of polyvalent testing. Impact on patient care is, however, still debatable. What has been highlighted is the need for health system strengthening and for true POC testing that can be used in active case finding.

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Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in HIV-positive adults

Cited by 126 publications

References 84 publications

Diagnosis of Tuberculosis in HIV Co‐infected Individuals: Current Status, Challenges and Opportunities for the Future

Diagnosis of Tuberculosis in HIV Co‐infected Individuals: Current Status, Challenges and Opportunities for the Future

Mycothiol acetyltransferase (Rv0819) ofMycobacterium tuberculosisis a potential biomarker for direct diagnosis of tuberculosis using patient serum specimens

Diagnosis of opportunistic infections

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