Positive Lateral Flow Urine Lipoarabinomannan Assay (LF-LAM) Result in Detection of Active Tuberculosis

Sara Puspita, Dewi Kartika Turbawaty, Nina Tristina, Leni Lismayanti


Lipoarabinomannan (LAM) is the main component of M. tuberculosis (MTB) wall as result of MTB degradation by macrophages in the human body. In patients with active TB and HIV co-infection, a decrease in antibody responses may be apparent that some of LAM may not be bound with antibodies. In this condition, LAM can pass through the normal glomerular basement membrane and can be detected in the urine. One laboratory examination for detecting LAM is the Lateral Flow Urine Lipoarabinomannan (LF-LAM) assay that uses urine as the sample. The purpose of this cross-sectional observational descriptive comparative study was to compare the positivity rate of LF-LAM examination results in active TB patients with and without HIV infection. Random urine samples were collected from patients diagnosed with active TB with and without HIV infection who visited Dr. Hasan Sadikin General Hospital Bandung from August to October 2020. The proportion between the group with HIV and group without HIV was analyzed with the Chi-Square test. Subjects were 52 patients, consisting of 25 (48%) subjects with HIV infection and 27 (52%) subjects without HIV infection. The positive LF-LAM results were found in 11 (21%) subjects, consisting of 9 (36%) subjects with HIV infection and 2 (7%) subjects without HIV infection, with p=0.012. In conclusion, the positivity rate of LF-LAM results is higher in active TB patients with HIV infection compared to those without HIV infection.



HIV; Lateral flow urine lipoarabinomannan assay (LF-LAM); TB

Full Text:



WHO. Global Tuberculosis Report 2019. France: WHO; 2019.

Keputusan Menteri Kesehatan Republik Indonesia Nomor Hk.01.07/Menkes/90/2019 Tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana HIV. Kemenkes RI: Jakarta; 2019.

WHO Guidelines Approved by the Guidelines Review Committee. WHO consolidated guidelines on tuberculosis: Module 3: diagnosis – rapid diagnostics for tuberculosis detection. Geneva: World Health Organization; 2020.

Lawn SD. Point-of-care detection of lipoarabinomannan (LAM) in urine for diagnosis of HIV-associated tuberculosis: a state of the art review. BMC Infec Dis. 2012;12(1):103.

WHO. Lateral Flow Urine Lipoarabinomannan Assay (LF-LAM) for the diagnosis of active tuberculosis in people living with HIV Policy update (2019). 2019.

Iskandar A, Nursiloningrum E, Arthamin MZ, Olivianto E, Chandrakusuma MS. The diagnostic value of urine lipoarabinomannan (lam) antigen in childhood tuberculosis. J Clin Diagn Res. 2017;11(3):EC32–EC35.

Singhroy D, MacLean E, Kohli M, Lessem E, Branigan D, England K, et al. Adoption and uptake of the lateral flow urine LAM test in countries with high tuberculosis and HIV/AIDS burden: current landscape and barriers. Gates Open Res. 2020;4:24.

Broger T, Sossen B, du Toit E, Kerkhoff AD, Schutz C, Ivanova Reipold E, et al. Novel lipoarabinomannan point-of-care tuberculosis test for people with HIV: a diagnostic accuracy study. Lancet Infect Dis. 2019;19(8):852–61.

Talbot E, Munseri P, Teixeira P, Matee M, Bakari M, Lahey T, et al. Test characteristics of urinary lipoarabinomannan and predictors of mortality among hospitalized hiv-infected tuberculosis suspects in Tanzania. PLOS ONE. 2012;7(3):e32876.

Cox J, Lukande R, Kalungi S, Van Marck E, Van de Vijver K, Kambugu A, et al. Is urinary lipoarabinomannan the result of renal tuberculosis? assessment of the renal histology in an autopsy cohort of Ugandan HIV-Infected adults. PLOS ONE. 2015;10:e0123323.

Wood R, Racow K, Bekker L-G, Middelkoop K, Vogt M, Kreiswirth BN, et al. Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria. BMC Infect Dis. 2012;12:47.

Suwanpimolkul G, Kawkitinarong K, Manosuthi W, Sophonphan J, Gatechompol S, Ohata PJ, et al. Utility of urine lipoarabinomannan (LAM) in diagnosing tuberculosis and predicting mortality with and without HIV: prospective TB cohort from the Thailand Big City TB Research Network. Int J Infect Dis. 2017;59:96–102.

Siddiqi OK, Birbeck GL, Ghebremichael M, Mubanga E, Love S, Buback C, et al. Prospective cohort study on performance of cerebrospinal fluid (CSF) Xpert MTB/RIF, CSF Lipoarabinomannan (LAM) Lateral Flow Assay (LFA), and urine LAM LFA for diagnosis of tuberculous meningitis in Zambia. J Clin Microbiol. 2019;57(8):e00652–19.

Ruffin N, Pham T, Rethi B, Nilsson A, Chiodi F. The impact of inflammation and immune activation on B cell differentiation during HIV-1 infection. Front Immunol. 2012;2:90.

Maduemem KE, Adedokun CO, Vatca A. Combined diagnosis of systemic lupus erythematosus and tuberculosis in an Irish adolescent female. Case Rep Pediatr. 2018:2031219.

DOI: https://doi.org/10.15395/mkb.v53n3.2265

Article Metrics

Abstract view : 1324 times
PDF - 573 times

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License


View My Stats