Detection of the Mycobacterium tuberculosis cell wall antigen lipoarabinomannan (LAM) in urine is a novel method for the diagnosis of tuberculosis (TB) in HIV-infected patients with advanced immunodeficiency. It is a lateral flow assay that can be used at the point of care and yields results in 30 minutes. The TB-LAM UA assay works best in HIV-infected patients with advanced immunosuppression, a population in which diagnosis of TB is particularly difficult. While the diagnostic properties of TB-LAM UA have been studied, little is known about the predictive and prognostic properties of TB-LAM UA at ART initiation. The test needs to be studied further to evaluate its possible applications and capacity. A positive TB-LAM UA test could enable targeted interventions such as altered therapy, and in the case of immunosuppressed patients with “hidden” TB, predict TB-associated immune reconstitution inflammatory syndrome (IRIS). We describe the predictive and prognostic properties of TB-LAM in HIV-positive patients initiating ART at an urban hospital in Johannesburg, South Africa.
Conference: SA TB conference 2014, Durban, SA