Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis.
Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis.
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DOI：
10.1186/s12890-016-0316-z
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发表时间：
2016-11-14
影响因子：
3.1
通讯作者：
Bassett IV
中科院分区：
文献类型：
--
作者：
Drain PK;Losina E;Coleman SM;Giddy J;Ross D;Katz JN;Bassett IV
世界卫生组织 (WHO) 建议在诊断艾滋病毒时进行结核病 (TB) 筛查。我们评估了在结核病筛查算法中纳入快速尿液阿拉伯脂甘露聚糖 (LAM) 检测。我们招募了未接受过抗逆转录病毒治疗的成年人，他们在夸祖鲁-纳塔尔省筛查了艾滋病毒感染者，评估了结核病相关症状（咳嗽、发烧、盗汗、体重减轻），并获取了痰标本进行分枝杆菌培养。训练有素的护士使用快速测定法进行临床尿液 LAM 检测。我们使用诊断准确性、阴性预测值 (NPV) 和阴性似然比（按 CD4 计数分层）来评估培养阳性结核病的筛查。在 675 名 CD4 中位数为 213/mm3（四分位数范围 85-360/mm3）的 HIV 感染成人中，123 人（18%）患有培养确诊的肺结核。世卫组织推荐的任何结核病相关症状的算法对于识别活动性肺结核的敏感性为 77% [95% 置信区间 (CI) 69-84%]，NPV 为 89% (95% CI 84-92%)。纳入 LAM 检测可提高灵敏度（83%；95% CI 75-89%）和 NPV（91%；95% CI 86-94%），同时降低阴性似然比（0.45 与 0.57）。在 CD4< 100/mm3 的参与者中，尿液 LAM 检测将基于症状的筛查的阴性预测值从 83% 提高到 87%。与 CD4 ≥ 100/mm3 的参与者相比，所有使用尿液 LAM 的筛查算法在 CD4 < 100/mm3 的参与者中表现更好。在结核病流行环境中，未接受过 ART 的 HIV 感染成人中，基于临床的尿液 LAM 筛查将基于症状的筛查的敏感性提高了 6%，从而提供了边际效益。
World Health Organization (WHO) recommends tuberculosis (TB) screening at HIV diagnosis. We evaluated the inclusion of rapid urine lipoarabinomannan (LAM) testing in TB screening algorithms. We enrolled ART-naïve adults who screened HIV-infected in KwaZulu-Natal, assessed TB-related symptoms (cough, fever, night sweats, weight loss), and obtained sputum specimens for mycobacterial culture. Trained nurses performed clinic-based urine LAM testing using a rapid assay. We used diagnostic accuracy, negative predictive value (NPV), and negative likelihood ratio, stratified by CD4 count, to evaluate screening for culture-positive TB. Among 675 HIV-infected adults with median CD4 of 213/mm3 (interquartile range 85-360/mm3), 123 (18%) had culture-confirmed pulmonary TB. The WHO-recommended algorithm of any TB-related symptom had a sensitivity of 77% [95% confidence interval (CI) 69-84%] and NPV of 89% (95% CI 84-92%) for identifying active pulmonary TB. Including the LAM assay improved sensitivity (83%; 95% CI 75-89%) and NPV (91%; 95% CI 86-94%), while decreasing the negative likelihood ratio (0.45 versus 0.57). Among participants with CD4 < 100/mm3, including urine LAM testing improved the negative predictive value of symptom based screening from 83% to 87%. All screening algorithms with urine LAM performed better among participants with CD4 < 100/mm3, compared to those with CD4 ≥ 100/mm3. Clinic-based urine LAM screening increased the sensitivity of symptom-based screening by 6% among ART-naïve HIV-infected adults in a TB-endemic setting, thereby providing marginal benefit.
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影响因子：
3.7
作者：
Hamasur B;Bruchfeld J;van Helden P;Källenius G;Svenson S
通讯作者：
Svenson S
影响因子：
3.7
作者：
Drain PK;Losina E;Coleman SM;Giddy J;Ross D;Katz JN;Walensky RP;Freedberg KA;Bassett IV
通讯作者：
Bassett IV
影响因子：
11.8
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Rangaka, Molebogeng X.;Wilkinson, Robert J.;Maartens, Gary
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通讯作者：
Varma JK
影响因子：
3.8
作者：
Lawn, Stephen D.;Edwards, David J.;Wood, Robin
通讯作者：
Wood, Robin