The utility of urine lipoarabinomannan as a tuberculosis treatment monitoring tool in people living with HIV

Objective This pilot study aimed to evaluate whether urine lipoarabinomannan (LAM) testing can be used to monitor tuberculosis treatment response in people living with HIV. Results Seventy-five participants were enrolled, of whom 51 (68%) were women, and 43 (57.4%) were antiretroviral therapy naïve. CD4 cell counts were available for 49 participants with a median of 58 cells/mm 3 (Interquartile range: 22-175). All participants initially tested positive for urine LAM; however, 12 (16%) converted to negative within two days of starting tuberculosis treatment. During the eight-week follow-up, 49 participants (65.3%) reverted from negative to positive at least once, primarily within the first two weeks, with notable peaks on day 4 (14, 28.6%) and day 5 (10, 20.4%). Of the 53 participants with urine LAM results at eight weeks, 26 participants (49.1%) had sustained urine LAM negativity. There was a significant LAM negativity trend from baseline to week 8 (Cochran-Armitage test for trend, p = 0.002). Urine LAM negativity did not significantly correlate with sputum smear or culture negativity (p = 0.521). These findings indicate that urine lipoarabinomannan testing is unreliable for monitoring tuberculosis treatment in people living with HIV, although repeated measurements offer insight into its performance in real-world settings.