title: Detection of lipoarabinomannan (LAM) in urine is indicative of disseminated TB with renal involvement in patients living with HIV and advanced immunodeficiency: evidence and implications.
abstract: TB is the leading cause of HIV/AIDS-related deaths globally. New diagnostic tools are urgently needed to avert deaths from undiagnosed HIV-associated TB. Although simple assays that detect lipoarabinomannan (LAM) in urine have been commercially available for years, their specific role and utility were initially misunderstood, such that they have been slower to emerge from the diagnostics pipeline than otherwise might have been expected. In this article, we review and explain how urine-LAM assays should be understood as diagnostics for disseminated TB in HIV-positive patients with advanced immunodeficiency, in whom haematogenous TB dissemination to the kidneys serves as the primary mechanism by which LAM enters the urine. These insights are critical for the appropriate design of studies to evaluate these assays and to understand how they might be most usefully implemented. This understanding also supports the 2015 WHO recommendations on the restricted use of these assays in sick HIV-positive patients with advanced immunodeficiency.
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa stephen.lawn@lshtm.ac.uk.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK Malawi-Liverpool-Wellcome Trust Clinical Research Program, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Ankur
authors.initials: A
authors.lastname: Gupta-Wright
mesh_terms: D015415:Biomarkers / Q000652:urine; D004797:Enzyme-Linked Immunosorbent Assay; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D008070:Lipopolysaccharides / Q000652:urine*; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000401:mortality
chemical_list: D015415:Biomarkers; D008070:Lipopolysaccharides; C050016:lipoarabinomannan
keywords: Diagnosis; Disseminated TB; HIV-associated TB; LAM; Lipoarabinomannan; Urine