Urine-Based Diagnostics for Tuberculosis in HIV-Infected Populations
Summary
Tuberculosis remains a leading cause of morbidity and mortality among people living with HIV, particularly in settings where immunosuppression limits sputum production and diminishes the sensitivity of conventional respiratory tests. Urine-based diagnostics harness the detection of mycobacterial antigens, notably lipoarabinomannan (LAM), which is shed in greater quantities during disseminated disease and advanced immunodeficiency. Point-of-care lateral-flow assays and laboratory-based chemiluminescence methods offer rapid turnaround and minimal biosafety requirements. These tests not only facilitate early case finding in patients unable to expectorate sputum but also complement nucleic acid amplification tests performed on respiratory or non-respiratory samples. Recent innovations have sought to enhance analytical sensitivity through improved antibody capture and signal amplification, while implementation studies have explored integration into routine hospital workflows. Taken together, urine-based diagnostics promise to overcome barriers posed by severe immunosuppression, support decentralised testing strategies and contribute to global efforts to reduce the diagnostic gap in HIV-associated tuberculosis.
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Urine-Based Diagnostics for Tuberculosis in HIV-Infected Populations publication trend
The graph below shows the total number of articles in urine-based diagnostics for tuberculosis in hiv-infected populations across all publications each year (not limited to Nature Index journals).
Technical terms
Lipoarabinomannan (LAM): A glycolipid component of the Mycobacterium tuberculosis cell wall detected in urine during disseminated infection.
Nucleic acid amplification test (NAAT): A molecular assay that identifies specific mycobacterial genetic sequences to confirm active disease.
Point-of-care test: A diagnostic procedure performed at the time and place of patient care, yielding rapid results without central laboratory facilities.
CD4 cell count: A measure of immune system status in HIV-infected individuals, indicating the degree of immunosuppression.
Extrapulmonary tuberculosis (EPTB): Tuberculosis infection occurring outside the lungs, often involving lymph nodes, abdomen or central nervous system.
References
- Diagnostic yield of urine lipoarabinomannan and sputum tuberculosis tests in people living with HIV: a systematic review and meta-analysis of individual participant data. The Lancet Global Health (2023).
- Diagnostic value of chemiluminescence for urinary lipoarabinomannan antigen assay in active tuberculosis: insights from a retrospective study. Frontiers in Cellular and Infection Microbiology (2023).
- Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study. Frontiers in Public Health (2024).
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