Diagnostic value of detection of LAM-antigen of mycobacteria tuberculosis in the urine of patients with HIV infection

• Olga V. Dobronravova
• Semen L. Maksimov
• Natalia N. Martynova
• Evgeniya V. Kukhtevich
• Vera N. Zimina
• Nikita A. Smirnov
• Artem V. Korovin
• Lyudmila M. Sidoruk

Abstract

Tuberculosis, as before, remains one of the main causes of deaths in HIV infected people. The problem of timely diagnosis of tuberculosis is one of the main unsolved health problems. Despite the availability of modern methods for diagnosing tuberculosis, the problem remains acute due to the high frequency of combined pathologies in patients with HIV infection. In recent years, a TB-LAM-test based on the detection of one of the antigenic structures of the Mycobacterium tuberculosis cell wall – lipoarabinomannan – in the urine of HIV infected patients has been used to diagnose generalized tuberculosis. Studies have shown that this test has a sensitivity of 67% and a specificity of 95%, and the informative value of the test increases with the progression of immunosuppression.

The aim of the study is to determine the possibility of using the TB-LAM-test in the algorithm of examination of HIV-infected patients with suspected tuberculosis upon admission to an infectious hospital.

Results. A preliminary diagnosis of tuberculosis was made in 31 (34.8%) of 89 patients who were transferred to TB hospitals for further diagnosis and treatment. TB-LAM-test was positive in 18 (20.2%)

of 89 patients included in the study. All 18 people with a positive test result for LAM-antigen were in the group of patients who were diagnosed and confirmed with active mycobacterial infection (31 patients) – tuberculosis or mycobacteriosis, which was 58.1%. In all patients with an unconfirmed diagnosis of mycobacterial infection, the result of the TB-LAM-test was negative. Among the patients with a positive result of the TB-LAM-test, 17 (94.4%) out of 18 had a final diagnosis of mycobacterial infection: the diagnosis of tuberculosis was in 15, mycobacteriosis was in 2. One patient dropped out of the study (the final diagnosis is unknown, is not registered at the dispensary).

Conclusion. In 18 HIV infected patients with a positive result of the TB-LAM-test in the morning urine portion, in 99.4% of cases, a final diagnosis of tuberculosis or mycobacteriosis was made. TB-LAM-test is a fast, specific and easy-to-perform research method for detecting mycobacterial infection in HIV infected patients at the stage of immunodeficiency.

Keywords:LAM-antigen; HIV infection; tuberculosis; mycobacteriosis

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