The use of Urinary Lipoarabinomannan (LAM) as a Rapid Diagnostic Test for Adult Pulmonary Tuberculosis in HIV-Positive Patients: An Evidence-based Case Report

Tuberculosis is a major health concerns around the world as it is causing morbidity and mortality, especially in HIV infected patients. Detection of lipoarabinomannan (LAM) on urine is a non-sputum-based diagnostic test for TB that could accelerate TB case detection in HIV-positive patients. This evidence-based case report was aimed to evaluate the diagnostic value of urinary Lipoarabinomannan (LAM) test in diagnosing pulmonary tuberculosis in HIV-positive patients as compared to sputum culture. Structured literature searching was done on cross-sectional or systematic reviews of diagnostic studies of lipoarabinomannan versus sputum culture in adult HIV-positive patients suspected with pulmonary TB. There were 9 articles that meet the eligibility criteria; 1 systematic review and 8 cross-sectional studies. Two out of nine articles were deemed as not valid due to not using sputum on all samples and the index test and reference test were not carried out on all samples. There were contradictory results regarding the sensitivity, positive predictive values and negative predictive values, meanwhile the specificity showed good results. We conclude that urinary LAM can be used to diagnose pulmonary TB in HIV-positive patients due to its high specificity. However, it could not be used as a stand-alone test, due to its suboptimal sensitivity.