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: Participants with a positive laboratory-based or rapid LAM test result after the 2-month intensive treatment phase had a greater risk of mortality during the 3-year follow-up period (table 4). Participants with a strongly positive rapid urine LAM result (â‰¥2+ grade) at the 2-month visit had an earlier median time to death (35.9â€…months), compared to participants with a weakly positive (1+ grade) or negative rapid urine LAM test (42.0â€…months) (p=0.02; figure 2). In univariate analyses, a positive laboratory-based LAM test or a rapid LAM grade â‰¥2+ at the 2-month visit was each significantly associated with all-cause mortality. In multivariate analyses adjusted for age, gender, Karnofsky performance score and HIV status, participants with a positive lab-based LAM test or a rapid LAM grade â‰¥2+ had a 4.13 (95% CI 0.88 to 19.4) and 5.58 (95% CI 1.24 to 25.2) hazard risk of death from any cause. Adjusting for the baseline CD4 count in the multivariate proportional hazard regression for the rapid LAM grade â‰¥2+ led to similar significant results (HR=5.01; 95% CI 1.05 to 23.9). Participants with a positive rapid LAM test at the 6-month visit had an adjusted hazard risk of 42.1 (95% CI 1.87 to 952) for mortality during the follow-up period. The HR remained significant when adjusting the same multivariate regression analysis for baseline CD4 count (HR=55.3; 95% CI 2.06 to 1484). The lab-based or rapid LAM test results at baseline were not significantly associated with mortality during the 3-year follow-up period.
Affiliation: Medical Practice Evaluation Center, Boston, Massachusetts, USA Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.