Urine lipoarabinomannan to monitor antituberculosis therapy response and predict mortality in an HIV-endemic region: a prospective cohort study.
Bottom Line: The primary outcome was change in urine LAM results during anti-TB therapy.In multivariate longitudinal analyses, urine LAM positivity and grade decreased among those with culture-confirmed pulmonary TB (p<0.0001), and had no change in sputum culture-negative participants.At the 2-month visit, participants with positive laboratory-based LAM or rapid LAM with ≥2+ grade had a significantly greater risk of mortality.
Affiliation: Medical Practice Evaluation Center, Boston, Massachusetts, USA Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.Show MeSH
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Mentions: Among LAM-positive participants at baseline, the mean urine LAM grade decreased from 2.2 (±1.5) at baseline to 1.3 (±1.9) at 2 months to 0.4 (±1.2) at the 6-month visit (figure 1A). Within our cohort, only one LAM-positive participant at baseline had an increase in urine LAM grade during the study period (1+ to 3+ at the 2-month visit); this person died during the 6-month study period. Among LAM-negative participants at baseline, there was no appreciable change in LAM score during 6 months of anti-TB therapy. However, one participant had a 1+ grade at the 2-month visit, and two participants had a 1+ grade at the 6-month visit. In multivariate longitudinal regression models, rapid urine LAM test positivity and test grade decreased among LAM-positive participants at baseline (both p=0.0001), and had no significant change among LAM-negative participants at baseline, during 6 months of anti-TB therapy.
Affiliation: Medical Practice Evaluation Center, Boston, Massachusetts, USA Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.