Urinary lipoarabinomannan for diagnosis of Tuberculosis in an HIV-negative population: A scoping review

Background Tuberculosis (TB) remains a leading cause of mortality in low-resource settings and poses a diagnostic challenge in human immunodeficiency virus (HIV)-negative populations because of limitations in traditional diagnostic methods such as sputum smear microscopy (SSM) and sputum Xpert Ultra. There is a lack of effective, non-invasive diagnostic options for TB diagnosis in HIV-negative populations. This scoping review explores the potential of urinary lipoarabinomannan (ULAM) as a point-of-care diagnostic tool for Mycobacterium tuberculosis (MTB) in HIV-negative individuals. Aim To evaluate the diagnostic performance of ULAM in detecting TB among HIV-negative populations and assess its feasibility as a rapid, non-invasive diagnostic method. Method A systematic search was conducted across PubMed, Google Scholar and Scopus. Articles were selected based on relevance to the topic. Results The search yielded 210 articles, with 11 meeting our inclusion criteria. These studies reported varying diagnostic performance metrics for ULAM: sensitivity ranged from 10.0% to 66.7% and specificity from 90.0% to 98.1% among different assays. Notably, the studies demonstrated that the novel assays such as Electrochemiluminescence LAM and the second-generation FujiLAM showed higher sensitivities of 66.7% and 53.2%, respectively. Despite these advancements, the overall effectiveness of ULAM in HIV-negative populations remains limited, with standard assays exhibiting sensitivities as low as 10.0%. Conclusion While ULAM holds potential as a diagnostic tool in HIV-associated TB, its application in HIV-negative populations is constrained by low sensitivity of the currently available assays.Contribution: The development and validation of high-sensitivity assays are crucial for broadening the utility of ULAM in these populations.