The study evaluated the accuracy of a urine lipoarabinomannan (U-LAM) test for diagnosing active tuberculosis (TB) in HIV-positive patients admitted to hospitals in South Africa with presumptive TB. Patients underwent testing for TB including sputum smear microscopy, mycobacterial culture, and the U-LAM test. The U-LAM test had a sensitivity of 59% for confirmed TB cases. Sensitivity was higher in HIV-positive versus negative patients and highest in those with CD4 counts below 50. Combining U-LAM and sputum smear identified 75% of confirmed TB cases. The U-LAM test shows potential as a simple, inexpensive test for TB

1. JAIDS, Aug 2009 Infectious Disease Journal Club 17 September 2007 Dr Preneshni Naicker

10. TB diagnostic categories Confirmed TB —M. tuberculosis cultured from any site, or microscopical examination of any specimen revealing AFB or granuloma(s) in the absence of a culture positive for any Mycobacteria. Possible TB —no culture positive for M. tuberculosis, and presence of clinical response to empiric TB treatment as defined by subjective report of improvement in cough, weight loss, and/or fever at 2-month follow-up. Not TB —cultures negative for M. tuberculosis, and  1 of the following: (a) alternative definitive microbiological diagnosis, (b) clinical improvement in the absence of TB treatment, and (c) failure to respond to empiric TB treatment. Indeterminate —failure to meet criteria for any of the above diagnostic categories

11. Results

21. Disease categorizations

25. LAM test performance

26. LAM performance by HIV status

30. U-LAM compared with Sputum Smear Microscopy

32. Comparison of LAM test performance 100% 38% (All) 67% (CD4 <50) Lawn 2009 Cape Town - 52% HIV + TBcul + Corbett 2003 Harare Unaffected by HIV status 99% 80.3% Boehme 2005 Tanzania Specificity Sensitivity