{"created":"2021-01-28T09:21:44.853238+00:00","id":7886,"links":{},"metadata":{"_buckets":{"deposit":"29723fcb-c66e-4444-9396-221611e76cee"},"_deposit":{"created_by":100,"id":"7886","owner":"100","owners":[100],"owners_ext":{"displayname":"hlahlawin","email":"hhlawin2013@gmail.com","username":"hlahlawin"},"pid":{"revision_id":0,"type":"depid","value":"7886"},"status":"published"},"_oai":{"id":"oai:meral.edu.mm:recid/00007886","sets":["1607984359018:1608053322572"]},"communities":["um2"],"item_1583103067471":{"attribute_name":"Title","attribute_value_mlt":[{"subitem_1551255647225":"The clinical utility of the urine-basedlateral flow lipoarabinomannan assayin HIV-infected adults in Myanmar:an observational study","subitem_1551255648112":"en"}]},"item_1583103085720":{"attribute_name":"Description","attribute_value_mlt":[{"interim":"Background:The use of the point-of-care lateral flow lipoarabinomannan (LF-LAM) test may expedite tuberculosis(TB) diagnosis in HIV-positive patients. However, the test’s clinical utility is poorly defined outside sub-Saharan Africa.Methods:The study enrolled consecutive HIV-positive adults at a tertiary referral hospital in Yangon, Myanmar. Onenrolment, patients had a LF-LAM test performed according to the manufacturer’s instructions. Clinicians managingthe patients were unaware of the LF-LAM result, which was correlated with the patient’s clinical course over theensuing 6 months.Results:The study enrolled 54 inpatients and 463 outpatients between July 1 and December 31, 2015. On enrolment,the patients’median (interquartile range) CD4 T-cell count was 270 (128–443) cells/mm3. The baseline LF-LAM testwas positive in 201/517 (39%). TB was confirmed microbiologically during follow-up in 54/517 (10%), with rifampicinresistance present in 8/54 (15%). In the study’s resource-limited setting, extrapulmonary testing for TB was not possible,but after 6 months, 97/201 (48%) with a positive LF-LAM test on enrolment had neither died, required hospitalisation,received a TB diagnosis or received empirical anti-TB therapy, suggesting a high rate of false-positive results.Of the 97 false-positive tests, 89 (92%) were grade 1 positive, suggesting poor test specificity using this cut-off. Only21/517 (4%) patients were inpatients with TB symptoms and a CD4 T-cell count of < 100 cells/mm3. Five (24%) of these21 died, three of whom had a positive LF-LAM test on enrolment. However, all three received anti-TB therapy beforedeath—two after diagnosis with Xpert MTB/RIF testing, while the other received empirical treatment. It is unlikely thatknowledge of the baseline LF-LAM result would have averted any of the study’s other 11 deaths; eight had a negativetest, and of the three patients with a positive test, two received anti-TB therapy before death, while one died fromlaboratory-confirmed cryptococcal meningitis. The test was no better than a simple, clinical history excluding TB duringfollow-up (negative predictive value (95% confidence interval): 94% (91–97) vs. 94% (91–96)).\nConclusions:The LF-LAM test had limited clinical utility in the management of HIV-positive patients in this Asianreferral hospital setting."}]},"item_1583103108160":{"attribute_name":"Keywords","attribute_value_mlt":[{"interim":"Human immunodeficiency virus"},{"interim":"Tuberculosis"},{"interim":"Diagnostic test"},{"interim":"Clinical management"},{"interim":"Myanmar"}]},"item_1583103120197":{"attribute_name":"Files","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_access","date":[{"dateType":"Available","dateValue":"2021-01-28"}],"displaytype":"preview","filename":"The_clinical_utility_of_the_urine-based_lateral_fl.pdf","filesize":[{"value":"1008 KB"}],"format":"application/pdf","licensetype":"license_0","url":{"url":"https://meral.edu.mm/record/7886/files/The_clinical_utility_of_the_urine-based_lateral_fl.pdf"},"version_id":"ba6012b0-69de-465f-9374-7d3beec14578"}]},"item_1583103131163":{"attribute_name":"Journal articles","attribute_value_mlt":[{"subitem_issue":"15","subitem_journal_title":"BMC Medicine","subitem_pages":"1-11"}]},"item_1583105942107":{"attribute_name":"Authors","attribute_value_mlt":[{"subitem_authors":[{"subitem_authors_fullname":"Swe Swe Thit"},{"subitem_authors_fullname":"Ne Myo Aung"},{"subitem_authors_fullname":"Zaw Win Htet"},{"subitem_authors_fullname":"Boyd, Mark A."},{"subitem_authors_fullname":"Htin Aung Saw"},{"subitem_authors_fullname":"Anstey, Nicholas M."},{"subitem_authors_fullname":"Tint Tint Kyi"},{"subitem_authors_fullname":"Cooper,  David A."},{"subitem_authors_fullname":"Mar Mar Kyi"},{"subitem_authors_fullname":"Hanson, Josh"}]}]},"item_1583108359239":{"attribute_name":"Upload type","attribute_value_mlt":[{"interim":"Publication"}]},"item_1583108428133":{"attribute_name":"Publication type","attribute_value_mlt":[{"interim":"Journal article"}]},"item_1583159729339":{"attribute_name":"Publication date","attribute_value":"2017-02-28"},"item_1583159847033":{"attribute_name":"Identifier","attribute_value":"DOI 10.1186/s12916-017-0888-3"},"item_title":"The clinical utility of the urine-basedlateral flow lipoarabinomannan assayin HIV-infected adults in Myanmar:an observational study","item_type_id":"21","owner":"100","path":["1608053322572"],"publish_date":"2021-01-28","publish_status":"0","recid":"7886","relation_version_is_last":true,"title":["The clinical utility of the urine-basedlateral flow lipoarabinomannan assayin HIV-infected adults in Myanmar:an observational study"],"weko_creator_id":"100","weko_shared_id":-1},"updated":"2021-12-13T00:26:36.464649+00:00"}