Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/110825
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dc.contributor.author | Thit, S. | - |
dc.contributor.author | Aung, N. | - |
dc.contributor.author | Htet, Z. | - |
dc.contributor.author | Boyd, M. | - |
dc.contributor.author | Saw, H. | - |
dc.contributor.author | Anstey, N. | - |
dc.contributor.author | Kyi, T. | - |
dc.contributor.author | Cooper, D. | - |
dc.contributor.author | Kyi, M. | - |
dc.contributor.author | Hanson, J. | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | BMC Medicine, 2017; 15(1):145-1-145-11 | - |
dc.identifier.issn | 1741-7015 | - |
dc.identifier.issn | 1741-7015 | - |
dc.identifier.uri | http://hdl.handle.net/2440/110825 | - |
dc.description.abstract | Background: The use of the point-of-care lateral flow lipoarabinomannan (LF-LAM) test may expedite tuberculosis (TB) diagnosis in HIV-positive patients. However, the test's clinical utility is poorly defined outside sub-Saharan Africa. Methods: The study enrolled consecutive HIV-positive adults at a tertiary referral hospital in Yangon, Myanmar. On enrolment, patients had a LF-LAM test performed according to the manufacturer's instructions. Clinicians managing the patients were unaware of the LF-LAM result, which was correlated with the patient's clinical course over the ensuing 6 months. Results: The study enrolled 54 inpatients and 463 outpatients between July 1 and December 31, 2015. On enrolment, the patients' median (interquartile range) CD4 T-cell count was 270 (128-443) cells/mm3. The baseline LF-LAM test was positive in 201/517 (39%). TB was confirmed microbiologically during follow-up in 54/517 (10%), with rifampicin resistance present in 8/54 (15%). In the study's resource-limited setting, extrapulmonary testing for TB was not possible, but after 6 months, 97/201 (48%) with a positive LF-LAM test on enrolment had neither died, required hospitalisation, received a TB diagnosis or received empirical anti-TB therapy, suggesting a high rate of false-positive results. Of the 97 false-positive tests, 89 (92%) were grade 1 positive, suggesting poor test specificity using this cut-off. Only 21/517 (4%) patients were inpatients with TB symptoms and a CD4 T-cell count of < 100 cells/mm3. Five (24%) of these 21 died, three of whom had a positive LF-LAM test on enrolment. However, all three received anti-TB therapy before death - two after diagnosis with Xpert MTB/RIF testing, while the other received empirical treatment. It is unlikely that knowledge of the baseline LF-LAM result would have averted any of the study's other 11 deaths; eight had a negative test, and of the three patients with a positive test, two received anti-TB therapy before death, while one died from laboratory-confirmed cryptococcal meningitis. The test was no better than a simple, clinical history excluding TB during follow-up (negative predictive value (95% confidence interval): 94% (91-97) vs. 94% (91-96)). Conclusions: The LF-LAM test had limited clinical utility in the management of HIV-positive patients in this Asian referral hospital setting. | - |
dc.description.statementofresponsibility | Swe Swe Thit, Ne Myo Aung, Zaw Win Htet, Mark A. Boyd, Htin Aung Saw, Nicholas M. Anstey, Tint Tint Kyi, David A. Cooper, Mar Mar Kyi and Josh Hanson | - |
dc.language.iso | en | - |
dc.publisher | BioMed Central | - |
dc.rights | © The Author(s). 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. | - |
dc.source.uri | http://dx.doi.org/10.1186/s12916-017-0888-3 | - |
dc.subject | Human immunodeficiency virus; tuberculosis; diagnostic test; clinical management; Myanmar; lipoarabinomannan | - |
dc.title | The clinical utility of the urine-based lateral flow lipoarabinomannan assay in HIV-infected adults in Myanmar: an observational study | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.1186/s12916-017-0888-3 | - |
dc.relation.grant | http://purl.org/au-research/grants/nhmrc/1054195 | - |
dc.relation.grant | http://purl.org/au-research/grants/nhmrc/1037304 | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Boyd, M. [0000-0002-6848-3307] | - |
Appears in Collections: | Aurora harvest 3 Medicine publications |
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hdl_110825.pdf | Published version | 1.16 MB | Adobe PDF | View/Open |
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