HIV coinfection with tuberculosis laboratory findings

A new rapid diagnostic test for TB disease, the Xpert MTB/RIF assay (which is not currently approved by the US Food and Drug Administration for use in the US), is expected to reduce patient and health service diagnostic delays, decentralize the diagnosis of MDR TB and HIV-associated TB, and accelerate patient access to appropriate care. Evidence suggests that use of the test might double the number of HIV-associated TB cases diagnosed in areas with high rates of TB and HIV.

Rapid HIV tests, using finger-prick or oral specimens, can also be used. Results are available in about 20 minutes. The rapid HIV test kits cost about $10. Although the rapid HIV test kits cost more than standard lab assays, they have been shown to be cost-effective. Also they increase patients’ acceptance to HIV testing. Another option is to collect oral swab specimens and use standard lab assays.

Lipoarabinomannan (LAM) is a glycolipid in the cell wall of mycobacteria that may be detected in urine .An inexpensive, point-of-care, lateral-flow LAM assay (Alere) is available.The sensitivity of the urinary LAM assay increases with lower CD4+ T-lymphocyte counts( but can give false positive results in infections with non tuberculous mycobacterial infections.) For countries with a high burden of HIV infection and tuberculosis, the WHO recommends the use of this assay in people with HIV infection if they have signs and symptoms of tuberculosis, are seriously ill, are inpatients with WHO clinical stage 3 or 4 disease, or have a CD4+ T-lymphocyte count of less than 200 per microliter (for inpatients) or less than 100 per microliter (for outpatients)

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