title: High diagnostic yield of tuberculosis from screening urine samples from HIV-infected patients with advanced immunodeficiency using the Xpert MTB/RIF assay.
abstract: We determined the diagnostic yield of the Xpert MTB/RIF assay for tuberculosis (TB) when testing small volumes of urine from ambulatory HIV-infected patients before starting antiretroviral therapy in South Africa. Compared with a gold standard of sputum culture, the sensitivity of urine Xpert among those with CD4 cell counts of <50, 50-100, and >100 cells per microliter were 44.4%, 25.0%, and 2.7% (P = 0.001), respectively. Urine Xpert testing provides a means of rapid TB diagnosis in patients with advanced immunodeficiency and poor prognosis. These data are indicative of high rates of TB dissemination and renal involvement in this clinical population.
authors.affiliation: The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. stevelawn@yahoo.co.uk
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Kerkhoff
authors.forename: Monica
authors.initials: M
authors.lastname: Vogt
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000652:urine; D000328:Adult; D000942:Antigens, Bacterial / Q000652:urine; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008070:Lipopolysaccharides / Q000652:urine; D008297:Male; D009169:Mycobacterium tuberculosis / Q000276:immunology / Q000302:isolation & purification; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis* / Q000652:urine; D016482:Urinalysis / Q000379:methods* / Q000706:statistics & numerical data
chemical_list: D000942:Antigens, Bacterial; D008070:Lipopolysaccharides; C050016:lipoarabinomannan