Disseminated tuberculosis among hospitalised HIV patients in South Africa: a common condition that can be rapidly diagnosed using urine-based assays

Kerkhoff, Andrew D, Barr, David A ORCID: 0000-0002-2922-9381, Schutz, Charlotte, Burton, Rosie, Nicol, Mark P, Lawn, Stephen D and Meintjes, Graeme (2017) Disseminated tuberculosis among hospitalised HIV patients in South Africa: a common condition that can be rapidly diagnosed using urine-based assays. Scientific Reports, 7 (1). 10931-.

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Official URL: http://dx.doi.org/10.1038/s41598-017-09895-7

Abstract

HIV-associated disseminated TB (tuberculosis) has been under-recognised and poorly characterised. Blood culture is the gold-standard diagnostic test, but is expensive, slow, and may under-diagnose TB dissemination. In a cohort of hospitalised HIV patients, we aimed to report the prevalence of TB-blood-culture positivity, performance of rapid diagnostics as diagnostic surrogates, and better characterise the clinical phenotype of disseminated TB. HIV-inpatients were systematically investigated using sputum, urine and blood testing. Overall, 132/410 (32.2%) patients had confirmed TB; 41/132 (31.1%) had a positive TB blood culture, of these 9/41 (22.0%) died within 90-days. In contrast to sputum diagnostics, urine Xpert and urine-lipoarabinomannan (LAM) combined identified 88% of TB blood-culture-positive patients, including 9/9 who died within 90-days. For confirmed-TB patients, half the variation in major clinical variables was captured on two principle components (PCs). Urine Xpert, urine LAM and TB-blood-culture positive patients clustered similarly on these axes, distinctly from patients with localised disease. Total number of positive tests from urine Xpert, urine LAM and MTB-blood-culture correlated with PCs (p < 0.001 for both). PC1&PC2 independently predicted 90-day mortality (ORs 2.6, 95%CI = 1.3-6.4; and 2.4, 95%CI = 1.3-4.5, respectively). Rather than being a non-specific diagnosis, disseminated TB is a distinct, life-threatening condition, which can be diagnosed using rapid urine-based tests, and warrants specific interventional trials.

Item Type:	Article
Uncontrolled Keywords:	Sputum, Blood, Urine, Humans, Tuberculosis, HIV Infections, Lipopolysaccharides, Diagnostic Tests, Routine, Prevalence, Survival Analysis, Hospitals, South Africa
Depositing User:	Symplectic Admin
Date Deposited:	14 Nov 2018 10:56
Last Modified:	19 Jan 2023 01:13
DOI:	10.1038/s41598-017-09895-7
Open Access URL:	https://www.nature.com/articles/s41598-017-09895-7
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3028675