{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T14:49:40Z","timestamp":1758811780362,"version":"3.37.3"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T00:00:00Z","timestamp":1614297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["UM1AI069465","RO1AI080417","UM1AI068613"],"award-info":[{"award-number":["UM1AI069465","RO1AI080417","UM1AI068613"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UM1AI068634","UM1AI068636","UM1AI106701","D43 TW009340"],"award-info":[{"award-number":["UM1AI068634","UM1AI068636","UM1AI106701","D43 TW009340"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009456","name":"Wyncote Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009456","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008799","name":"Gilead Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008799","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000070","name":"National Institute of Biomedical Imaging and Bioengineering","doi-asserted-by":"publisher","award":["U54EB007958"],"award-info":[{"award-number":["U54EB007958"]}],"id":[{"id":"10.13039\/100000070","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43TW009771","D43TW009340","D43TW010132"],"award-info":[{"award-number":["D43TW009771","D43TW009340","D43TW010132"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The urine lipoarabinomannan (LAM) antigen test is a tuberculosis (TB) diagnostic test with highest sensitivity in individuals with advanced human immunodeficiency virus (HIV). Its role in TB diagnostic algorithms for HIV-positive outpatients remains unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The AIDS Clinical Trials Group (ACTG) A5274 trial demonstrated that empiric TB therapy did not improve 24-week survival compared to isoniazid preventive therapy (IPT) in TB screen\u2013negative HIV-positive adults initiating antiretroviral therapy with CD4 counts &amp;lt;50 cells\/\u00b5L. Retrospective LAM testing was performed on stored urine obtained at baseline. We determined the proportion of LAM-positive participants and conducted modified intent-to-treat analysis excluding LAM-positive participants to determine the effect on 24-week survival, TB incidence, and time to TB using Kaplan-Meier method.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A5274 enrolled 850 participants; 53% were male and the median CD4 count was 18 (interquartile range, 9\u201332) cells\/\u00b5L. Of the 850, 566 (67%) had LAM testing (283 per arm); 28 (5%) were positive (21 [7%] and 7 [2%] in the empiric and IPT arms, respectively). Of those LAM-positive, 1 participant in each arm died and 5 of 21 and 0 of 7 in empiric and IPT arms, respectively, developed TB. After excluding these 28 cases, there were 19 and 21 deaths in the empiric and IPT arms, respectively (P = .88). TB incidence remained higher (4.6% vs 2%, P = .04) and time to TB remained faster in the empiric arm (P = .04).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Among outpatients with advanced HIV who screened negative for TB by clinical symptoms, microscopy, and Xpert testing, LAM testing identified an additional 5% of individuals with TB. Positive LAM results did not change mortality or TB incidence.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab179","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T20:29:53Z","timestamp":1614112193000},"page":"e870-e877","source":"Crossref","is-referenced-by-count":4,"title":["Urine Lipoarabinomannan Testing in Adults With Advanced Human Immunodeficiency Virus in a Trial of Empiric Tuberculosis Therapy"],"prefix":"10.1093","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6542-8193","authenticated-orcid":false,"given":"Mitch M","family":"Matoga","sequence":"first","affiliation":[{"name":"University of North Carolina Project, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory P","family":"Bisson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7036-2718","authenticated-orcid":false,"given":"Amita","family":"Gupta","sequence":"additional","affiliation":[{"name":"Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachiko","family":"Miyahara","sequence":"additional","affiliation":[{"name":"Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Sun","sequence":"additional","affiliation":[{"name":"Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie","family":"Fry","sequence":"additional","affiliation":[{"name":"Frontier Science Foundation, Amherst, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukari C","family":"Manabe","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnstone","family":"Kumwenda","sequence":"additional","affiliation":[{"name":"Malawi College of Medicine\u2013Johns Hopkins University Research Project, Blantyre, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanyama","family":"Cecilia","sequence":"additional","affiliation":[{"name":"University of North Carolina Project, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mulinda","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"Malawi College of Medicine\u2013Johns Hopkins University Research Project, Blantyre, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"McNeil","family":"Ngongondo","sequence":"additional","affiliation":[{"name":"University of North Carolina Project, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abineli","family":"Mbewe","sequence":"additional","affiliation":[{"name":"University of North Carolina Project, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Lagat","sequence":"additional","affiliation":[{"name":"Moi University School of Medicine, Eldoret, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carole","family":"Wallis","sequence":"additional","affiliation":[{"name":"Bioanalytical Research Corporation and Lancet Laboratories, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry","family":"Mugerwa","sequence":"additional","affiliation":[{"name":"Joint Clinical Research Centre, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina C","family":"Hosseinipour","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,2,26]]},"reference":[{"year":"2019","author":"World Health Organization","key":"2021081616423967400_CIT0001"},{"year":"2015","author":"World Health Organization","key":"2021081616423967400_CIT0002"},{"key":"2021081616423967400_CIT0003","doi-asserted-by":"crossref","first-page":"e0170976","DOI":"10.1371\/journal.pone.0170976","article-title":"Incremental yield of including Determine-TB LAM assay 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