PMID- 21963941
OWN - NLM
STAT- MEDLINE
DCOM- 20120103
LR  - 20200930
IS  - 1944-7884 (Electronic)
IS  - 1525-4135 (Linking)
VI  - 58
IP  - 5
DP  - 2011 Dec 15
TI  - Urinary lipoarabinomannan as predictor for the tuberculosis immune reconstitution 
      inflammatory syndrome.
PG  - 463-8
LID - 10.1097/QAI.0b013e31823801de [doi]
AB  - 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.
FAU - Conesa-Botella, Anali
AU  - Conesa-Botella A
AD  - Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, 
      Belgium. aconesa@itg.be
FAU - Loembe, Marguerite Massinga
AU  - Loembe MM
FAU - Manabe, Yukari C
AU  - Manabe YC
FAU - Worodria, William
AU  - Worodria W
FAU - Mazakpwe, Doreen
AU  - Mazakpwe D
FAU - Luzinda, Kenneth
AU  - Luzinda K
FAU - Mayanja-Kizza, Harriet
AU  - Mayanja-Kizza H
FAU - Miri, Mitra
AU  - Miri M
FAU - Mbabazi, Olive
AU  - Mbabazi O
FAU - Koole, Olivier
AU  - Koole O
FAU - Kestens, Luc
AU  - Kestens L
FAU - Colebunders, Robert
AU  - Colebunders R
CN  - TB IRIS Group
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Acquir Immune Defic Syndr
JT  - Journal of acquired immune deficiency syndromes (1999)
JID - 100892005
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antitubercular Agents)
RN  - 0 (Lipopolysaccharides)
RN  - 0 (lipoarabinomannan)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/therapeutic use
MH  - Antiretroviral Therapy, Highly Active
MH  - Antitubercular Agents/*therapeutic use
MH  - Case-Control Studies
MH  - Cohort Studies
MH  - Female
MH  - HIV Infections/*complications/drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*etiology/urine
MH  - Lipopolysaccharides/*urine
MH  - Male
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Risk Factors
MH  - Tuberculosis/*complications/*drug therapy
MH  - Uganda
FIR - Kestens, Luc
IR  - Kestens L
FIR - Colebunders, Robert
IR  - Colebunders R
FIR - Massinga Loembe, Marguerite
IR  - Massinga Loembe M
FIR - Mayanja-Kizza, Harriet
IR  - Mayanja-Kizza H
FIR - Worodria, William
IR  - Worodria W
FIR - Mayanja-Kizza, Harriet
IR  - Mayanja-Kizza H
FIR - Mascart, Francoise
IR  - Mascart F
FIR - van den Bergh, Rafael
IR  - van den Bergh R
FIR - Locht, Camille
IR  - Locht C
FIR - Reiss, Peter
IR  - Reiss P
FIR - Cobelens, Frank
IR  - Cobelens F
FIR - Ondoa, Pascale
IR  - Ondoa P
FIR - Pakker, Nadine
IR  - Pakker N
FIR - Mugerwa, Roy
IR  - Mugerwa R
FIR - Mayanja-Kizza, Harriet
IR  - Mayanja-Kizza H
FIR - Pakker, Nadine
IR  - Pakker N
FIR - Worodria, William
IR  - Worodria W
EDAT- 2011/10/04 06:00
MHDA- 2012/01/04 06:00
CRDT- 2011/10/04 06:00
PHST- 2011/10/04 06:00 [entrez]
PHST- 2011/10/04 06:00 [pubmed]
PHST- 2012/01/04 06:00 [medline]
AID - 10.1097/QAI.0b013e31823801de [doi]
PST - ppublish
SO  - J Acquir Immune Defic Syndr. 2011 Dec 15;58(5):463-8. doi: 
      10.1097/QAI.0b013e31823801de.