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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Urinary lipoarabinomannan as predictor for the tuberculosis immune reconstitution inflammatory syndrome
Journal of Acquired Immune Deficiency Syndromes, Volume 58, No. 5, Year 2011
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Description
Background: Upon initiation of antiretroviral therapy (ART), 15.7% [95% confidence interval (CI): 9.7% to 24.5%] of tuberculosis (TB)-HIV-coinfected individuals experience paradoxical worsening of their clinical status with exuberant inflammation consistent with immune reconstitution inflammatory syndrome (IRIS). We investigated whether a positive urinary TB lipoarabinomannan (LAM) antigen enzyme-linked immunosorbent assay test before ART initiation was associated with development of paradoxical TB-IRIS. Methods: In a prospective observational cohort in Mulago Hospital, Kampala, Uganda, we measured pre-ART urinary LAM concentrations in HIV-infected patients on TB treatment. Patients who developed TB-IRIS (according to the International Network for the Study of HIV-associated IRIS case definition) were compared with patients who remained IRIS free for at least 3 months. Results: Twenty-six individuals with TB-IRIS and 64 without IRIS were included in the analysis. The median time to TB-IRIS was 14 days (interquartile range: 11-14 days). Univariate analysis showed that a positive pre-ART urinary LAM test [OR: 4.6 (95% CI: 1.5 to 13.8), P = 0.006] and a CD4 count <50 cells/mL [OR: 21 (95% CI: 2.6 to 169.4), P = 0.004] were associated with an increased risk of TB-IRIS. In multivariate analysis, only a baseline CD4 T-cell count <50 cells/mL was predictive of IRIS (P < 0.004). Sensitivity and specificity of a positive pre-ART urinary LAM test to diagnose IRIS were 80.8% (95% CI: 60.6 to 93.4) and 52.4% (95% CI: 39.4 to 65.1), respectively. Conclusions: If CD4 T-cell count testing is available, a pre-highly active antiretroviral therapy urinary LAM test has no added value to predict TB-IRIS. When CD4 T-cell count is not available, a positive LAM test could identify patients at increased risk of TB-IRIS. © 2011 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Conesa-Botella, Anali
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Belgium, Antwerpen
Universiteit Antwerpen
Massinga-Loembé, Marguérite
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Manabe, Yukari C.
Uganda, Kampala
Makerere University College of Health Sciences
United States, Baltimore
Johns Hopkins School of Medicine
Uganda, Kampala
Infectious Diseases Network for Treatment and Research in Africa
Worodria, William O.
Uganda, Kampala
Makerere University College of Health Sciences
Uganda, Kampala
Infectious Diseases Network for Treatment and Research in Africa
Mazakpwe, D.
Uganda, Kampala
Infectious Diseases Network for Treatment and Research in Africa
Uganda, Kampala
Makerere University College of Health Sciences
Luzinda, K.
Uganda, Kampala
Infectious Diseases Network for Treatment and Research in Africa
Uganda, Kampala
Makerere University College of Health Sciences
Mayanja-Kizza, Harriet
Uganda, Kampala
Makerere University College of Health Sciences
Miri, Mitra
United States, New Haven
Yale University
Mbabazi, Olive
Uganda, Kampala
Makerere University College of Health Sciences
Koole, Olivier
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Kestens, Luc L.
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Belgium, Antwerpen
Universiteit Antwerpen
Colebunders, Robert Leon
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Belgium, Antwerpen
Universiteit Antwerpen
Statistics
Citations: 38
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.1097/QAI.0b013e31823801de
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
Uganda