دورية أكاديمية
أعرض في EDS

Rapid urine-based screening tests increase the yield of same-day tuberculosis diagnoses among patients living with advanced HIV disease.

التفاصيل البيبلوغرافية
العنوان: Rapid urine-based screening tests increase the yield of same-day tuberculosis diagnoses among patients living with advanced HIV disease.
المؤلفون: Wake RM; Institute for Infection and Immunity, St George's University of London.; Clinical Academic Group in Infection and Immunity, St George's University Hospital NHS Foundation Trust, London, UK.; Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses (CHARM), National Institute for Communicable Diseases, a Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa., Govender NP; Institute for Infection and Immunity, St George's University of London.; Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses (CHARM), National Institute for Communicable Diseases, a Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK.; Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand.; Division of Medical Microbiology, University of Cape Town, Cape Town., Omar SV; Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand.; Department of Medical Microbiology, University of Pretoria, Pretoria.; Centre for Tuberculosis., Ismail F; Department of Medical Microbiology, University of Pretoria, Pretoria.; Centre for Tuberculosis., Tiemessen CT; Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand.; Centre for HIV & STIs, National Institute for Communicable Diseases, a Division of the NHLS, Johannesburg, South Africa., Harrison TS; Institute for Infection and Immunity, St George's University of London.; Clinical Academic Group in Infection and Immunity, St George's University Hospital NHS Foundation Trust, London, UK.; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK., Jarvis JN; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.; Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana.
المصدر: AIDS (London, England) [AIDS] 2022 May 01; Vol. 36 (6), pp. 839-844. Date of Electronic Publication: 2022 Jan 24.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: England NLM ID: 8710219 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1473-5571 (Electronic) Linking ISSN: 02699370 NLM ISO Abbreviation: AIDS Subsets: MEDLINE
أسماء مطبوعة: Publication: 1998- : London, England : Lippincott Williams & Wilkins
Original Publication: London : Gower Academic Journals, c1987-
مواضيع طبية MeSH: HIV Infections*/epidemiology , Mycobacterium tuberculosis* , Tuberculosis*/diagnosis , Tuberculosis, Pulmonary*/complications , Tuberculosis, Pulmonary*/diagnosis, Cross-Sectional Studies ; Humans ; Lipopolysaccharides ; Sensitivity and Specificity ; South Africa/epidemiology ; Sputum
مستخلص: Objective: Investigation of the diagnostic yield of urine-based tuberculosis (TB) screening in patients with advanced HIV disease.
Design: A cross-sectional screening study.
Setting: HIV outpatient clinics and wards at two hospitals in Johannesburg, South Africa, between June 2015 and October 2017.
Participants: Two hundred and one patients living with advanced HIV disease (CD4+ T-lymphocytes <100 cells/μl) attending healthcare facilities following cryptococcal antigen (CrAg) screening.
Intervention: Screening for TB using sputum for microscopy, culture, and Xpert MTB/Rif and urine for lipoarabinomannan (LAM) and Xpert Ultra.
Main Outcome Measures: Proportion of positive results using each testing modality, sensitivity, and specificity of urine-based testing compared with culture, and survival outcomes during 6 months follow up.
Results: Urine was obtained from 177 of 181 (98%) participants and sputum from 91 (50%). Urine-based screening increased same-day diagnostic yield from 7 (4%) to 31 (17%). A positive urine test with either LAM or Xpert Ultra had 100% sensitivity (95% confidence interval, 59-100%) for detecting culture-positive TB at any site. Patients with newly diagnosed TB on urine-based screening were initiated on treatment and did not have excess mortality compared with the remainder of the cohort.
Conclusion: Urine is an easily obtainable sample with utility for detecting TB in patients with advanced HIV disease. Combining urine and sputum-based screening in this population facilitates additional same-day TB diagnoses and early treatment initiation, potentially reducing the risk of TB-related mortality. Urine-based as well as sputum-based screening for TB should be integrated with CrAg screening in patients living with advanced HIV disease.
(Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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معلومات مُعتمدة: MR/V033417/1 United Kingdom MRC_ Medical Research Council; R01 AI118511 United States AI NIAID NIH HHS; RP-2017-08-ST2-012 United Kingdom DH_ Department of Health
المشرفين على المادة: 0 (Lipopolysaccharides)
تواريخ الأحداث: Date Created: 20220125 Date Completed: 20220505 Latest Revision: 20240511
رمز التحديث: 20240511
DOI: 10.1097/QAD.0000000000003177
PMID: 35075041
قاعدة البيانات: MEDLINE
الوصف
تدمد:1473-5571
DOI:10.1097/QAD.0000000000003177