Detection of lipoarabinomannan (LAM) in urine is indicative of disseminated TB with renal involvement in patients living with HIV and advanced immunodeficiency: evidence and implications.
Detection of lipoarabinomannan (LAM) in urine is indicative of disseminated TB with renal involvement in patients living with HIV and advanced immunodeficiency: evidence and implications.
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DOI：
10.1093/trstmh/trw008
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发表时间：
2016-03
影响因子：
2.2
通讯作者：
Gupta-Wright A
中科院分区：
文献类型：
--
作者：
Lawn SD;Gupta-Wright A
结核病是全球艾滋病毒/艾滋病相关死亡的主要原因。迫切需要新的诊断工具，以避免因未确诊的艾滋病毒相关结核病而死亡。尽管检测尿液中脂阿拉伯糖甘露聚糖（LAM）的简单检测方法已经商业化多年，但它们的具体作用和用途最初被误解，因此它们从诊断管道中出现的速度比预期的要慢。在这篇文章中，我们回顾并解释了尿-LAM检测应该如何被理解为晚期免疫缺陷hiv阳性患者弥散性结核病的诊断，在这些患者中，血液源性结核病传播到肾脏是LAM进入尿液的主要机制。这些见解对于适当设计研究以评估这些分析并了解如何最有效地实施这些分析至关重要。这一认识也支持了2015年世卫组织关于在晚期免疫缺陷的艾滋病毒阳性患者中限制使用这些检测方法的建议。
TB is the leading cause of HIV/AIDS-related deaths globally. New diagnostic tools are urgently needed to avert deaths from undiagnosed HIV-associated TB. Although simple assays that detect lipoarabinomannan (LAM) in urine have been commercially available for years, their specific role and utility were initially misunderstood, such that they have been slower to emerge from the diagnostics pipeline than otherwise might have been expected. In this article, we review and explain how urine-LAM assays should be understood as diagnostics for disseminated TB in HIV-positive patients with advanced immunodeficiency, in whom haematogenous TB dissemination to the kidneys serves as the primary mechanism by which LAM enters the urine. These insights are critical for the appropriate design of studies to evaluate these assays and to understand how they might be most usefully implemented. This understanding also supports the 2015 WHO recommendations on the restricted use of these assays in sick HIV-positive patients with advanced immunodeficiency.