{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:07:54Z","timestamp":1785434874189,"version":"3.56.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T00:00:00Z","timestamp":1678233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100003323","name":"Agence Nationale de Recherche sur le Sida et les h\u00e9patites virales","doi-asserted-by":"publisher","award":["ANRS grant number 12290"],"award-info":[{"award-number":["ANRS grant number 12290"]}],"id":[{"id":"10.13039\/501100003323","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In people with human immunodeficiency virus (PWH), the World Health Organization\u2013recommended tuberculosis (TB) 4-symptom screen (W4SS) targeting those who need molecular rapid testing may be suboptimal. We assessed the performance of different TB screening approaches in severely immunosuppressed PWH enrolled in the guided-treatment group of the STATIS trial (NCT02057796).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Ambulatory PWH with no overt evidence of TB and CD4 count &amp;lt;100 cells\/\u00b5L were screened for TB prior to antiretroviral therapy (ART) initiation with W4SS, chest radiograph (CXR), urine lipoarabinomannan (LAM) test, and sputum Xpert MTB\/RIF (Xpert). Correctly and wrongly identified cases by screening approaches were assessed overall and by CD4 count threshold (\u226450 and 51\u201399 cells\/\u00b5L).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 525 enrolled participants (median CD4 count, 28 cells\/\u00b5L), 48 (9.9%) were diagnosed with TB at enrollment. Among participants with a negative W4SS, 16% had either a positive Xpert, a CXR suggestive of TB, or a positive urine LAM test. The combination of sputum Xpert and urine LAM test was associated with the highest proportion of participants correctly identified as TB (95.8%) and non-TB cases (95.4%), with proportions equally high among participants with CD4 counts above or below 50 cells\/\u00b5L. Restricting the use of sputum Xpert, urine LAM test, or CXR to participants with a positive W4SS reduced the proportion of wrongly and correctly identified cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There is a clear benefit to perform both sputum Xpert and urine LAM tests as TB screening in all severely immunosuppressed PWH prior to ART initiation, not only in those with a positive W4SS.<\/jats:p>\n                  <jats:p>Clinical Trials Registration. NCT02057796.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad125","type":"journal-article","created":{"date-parts":[[2023,3,7]],"date-time":"2023-03-07T17:23:46Z","timestamp":1678209826000},"page":"112-119","source":"Crossref","is-referenced-by-count":7,"title":["High Performance of Systematic Combined Urine Liboarabinomannan Test and Sputum Xpert MTB\/RIF for Tuberculosis Screening in Severely Immunosuppressed Ambulatory Adults With Human Immunodeficiency Virus"],"prefix":"10.1093","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1071-7393","authenticated-orcid":false,"given":"Maryline","family":"Bonnet","sequence":"first","affiliation":[{"name":"University of Montpellier, TransVIH MI, Institut de Recherche pour le D\u00e9veloppement (IRD) , Inserm, Montpellier ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delphine","family":"Gabillard","sequence":"additional","affiliation":[{"name":"IRD, Inserm, University of 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