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

Abstract

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.