Urinary lipoarabinomannan as predictor for the tuberculosis immune reconstitution inflammatory syndrome

A Conesa-Botella, M Massinga-Loembe, YC Manabe, W Worodria, D Mazakpwe, K Luzinda, H Mayanja-Kizza, M Miri, O Mbabazi, O Koole, L Kestens, R Colebunders

    Research output: Contribution to journalA1: Web of Science-article

    Abstract

    BACKGROUND: Upon initiation of antiretroviral therapy (ART), 15.7% (95%CI: 9.7%-24.5%) of tuberculosis (TB)-HIV co-infected 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 ELISA-test prior to 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 (INSHI) case-definition) were compared to 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 (IQR: 11-14). Univariate analysis showed that a positive pre-ART urinary LAM test (OR: 4.6 [95%CI: 1.5-13.8], p=0.006) and a CD4 count <50 cells/ml (OR: 21 [95%CI: 2.6-169.4], 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 was 80.8% (95%CI: 60.6-93.4) and 52.4% (95%CI: 39.4-65.1), respectively. CONCLUSION: If CD4 T-cell count testing is available, a pre-HAART 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.
    Original languageEnglish
    JournalJournal of Acquired Immune Deficiency Syndromes
    Volume58
    Issue number5
    Pages (from-to)463-468
    Number of pages6
    ISSN1525-4135
    DOIs
    Publication statusPublished - 2011

    Keywords

    • B780-tropical-medicine
    • Viral diseases
    • HIV
    • AIDS
    • Co-infections
    • Bacterial diseases
    • Tuberculosis
    • Mycobacterium tuberculosis
    • Immune reconstitution inflammatory syndrome (IRIS)
    • IRIS
    • HAART
    • Antiretrovirals
    • Testing
    • ELISA
    • Antigen detection
    • Diagnosis
    • Lipoarabinomannan
    • Urinanalysis
    • Associations
    • CD4-positive-T-lymphocytes
    • Uganda
    • Africa-East

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