{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:09:18Z","timestamp":1790226558655,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,2,3]]},"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine if urinary lipoarabinomannan (LAM) may serve as a biomarker to monitor antituberculosis (TB) therapy response, and whether LAM results before and after treatment are predictive of patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Outpatient referral clinic and tertiary hospital in South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults (\u226518\u2005years) with \u22652 TB-related symptoms (cough, fever, weight loss, night sweats) for \u22652\u2005weeks being initiated on anti-TB therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>On enrolment, we obtained urine and nebulised sputum specimens, offered HIV testing and started participants on anti-TB therapy for \u22656\u2005months. We collected urine samples after the 2-month intensive treatment phase and at the completion of anti-TB therapy. Positive LAM results were graded from 1 (low) to 5 (high). Participants were followed for &gt;3\u2005years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was change in urine LAM results during anti-TB therapy. The secondary outcome was all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 90 participants, 57 (63%) had culture-confirmed pulmonary TB. Among the 88 participants tested, 82 (93%) were HIV-infected with median CD4 168\/mm\n                      <jats:sup>3<\/jats:sup>\n                      (IQR 89\u2013256\/mm\n                      <jats:sup>3<\/jats:sup>\n                      ). During anti-TB therapy, the percentage of LAM-positive participants decreased from baseline to 2\u2005months (32% to 16%), and from baseline to 6-months (32% to 10%) (p values &lt;0.005). In multivariate longitudinal analyses, urine LAM positivity and grade decreased among those with culture-confirmed pulmonary TB (p&lt;0.0001), and had no change in sputum culture-negative participants. At the 2-month visit, participants with positive laboratory-based LAM or rapid LAM with \u22652+ grade had a significantly greater risk of mortality. In analyses adjusted for age, sex, baseline Karnofsky score and HIV status, participants with a rapid LAM \u22652+ grade after 2\u2005months of anti-TB therapy had a 5.6-fold (95% CI 1.2 to 25.2) greater risk of mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rapid urine LAM testing may be a valuable tool to monitor anti-TB therapy response and to assess prognosis of patients being treated for pulmonary TB in HIV-endemic regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2014-006833","type":"journal-article","created":{"date-parts":[[2015,4,15]],"date-time":"2015-04-15T22:31:12Z","timestamp":1429137072000},"page":"e006833","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":34,"title":["Urine lipoarabinomannan to monitor antituberculosis therapy response and predict mortality in an HIV-endemic region: a prospective cohort study"],"prefix":"10.1136","volume":"5","author":[{"given":"Paul K","family":"Drain","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Boston, Massachusetts, USA"},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilishia","family":"Gounder","sequence":"additional","affiliation":[{"name":"Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke","family":"Grobler","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faieza","family":"Sahid","sequence":"additional","affiliation":[{"name":"University of Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid V","family":"Bassett","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Boston, Massachusetts, USA"},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahomed-Yunus S","family":"Moosa","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,4,15]]},"reference":[{"key":"2025121221223281000_5.4.e006833.1","unstructured":"World Health Organization. Global TB Report 2012. Geneva: World Health Organization, 2012."},{"key":"2025121221223281000_5.4.e006833.2","unstructured":"World Health Organization. Joint TB\/HIV Interventions. 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Geneva: World Health Organization, 2010."},{"key":"2025121221223281000_5.4.e006833.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907847"},{"key":"2025121221223281000_5.4.e006833.10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001067"},{"key":"2025121221223281000_5.4.e006833.11","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1183\/09031936.00124711","article-title":"Early tuberculosis treatment monitoring by Xpert MTB\/Rif","volume":"39","author":"Miotto","year":"2013","journal-title":"Euro Resp J"},{"key":"2025121221223281000_5.4.e006833.12","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S0167-7012(01)00239-1","article-title":"Rapid diagnosis of tuberculosis by detection of mycobacterial lipoarabinomannan in urine","volume":"45","author":"Hamasur","year":"2001","journal-title":"J Micro Methods"},{"key":"2025121221223281000_5.4.e006833.13","unstructured":"Sahid F , Thumbiran NV , Gounder L , et al . Diagnosis of smear negative HIV associated pulmonary tuberculosis: a comparison of sputum obtained by a novel intra-oesophageal device with induced sputum. Seattle: Conference on Retroviruses and Opportunistic Infections, 2012."},{"key":"2025121221223281000_5.4.e006833.14","unstructured":"World Health Organization. Systematic screening for active tuberculosis: principles and recommendations. Geneva: World Health Organization, 2013 (WHO\/HTM\/TB\/2013.04)."},{"key":"2025121221223281000_5.4.e006833.15","unstructured":"National Department of Health, Republic of South Africa. Clinical guidelines for the management of HIV & AIDS in adults and adolescents. South Africa: Department of Health, 2010."},{"key":"2025121221223281000_5.4.e006833.16","unstructured":"Alere Inc. DetermineTM TB LAM test. Waltham, USA. http:\/\/www.alere.com\/au\/en\/product-details\/determine-tb-lam.html (accessed 22 Mar 2013)."},{"key":"2025121221223281000_5.4.e006833.17","unstructured":"Drain PK , Gounder L , Grobler A , et al. Point-of-Care Urine Lipoarabinomannan (LAM) for Diagnosis and Treatment Response of Pulmonary Tuberculosis in Sputum Smear-Negative Suspects. 44th Union World Conference on Lung Health on November 2, 2013."},{"key":"2025121221223281000_5.4.e006833.18","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00201711"},{"key":"2025121221223281000_5.4.e006833.19","unstructured":"Dorman S , Manabe Y , Nicol M , et al . Accuracy of Determine TB-Lipoarabinomannan lateral flow test for diagnosis of TB and HIV+ adults: Interim results from a multicenter study. Abstract of the 19th Conference on Retroviruses and Opportunistic Infection. Seattle, WA, 2012. 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Accuracy of Determine TB-Lipoarabinomannan lateral flow test for diagnosis of TB and HIV+ adults: Interim results from a multicenter study. 19th Conference on Retroviruses and Opportunistic Infection. Seattle, 2012. 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