8/7/2023 0 Comments Eliza lam testThe PICO questions shown in Box 2.2.2 were designed to form the basis for the evidence search, retrieval and analysis. 2.2.3b).ĪlereLAM is being considered as a diagnostic test that may be used in combination with existing tests for the diagnosis of HIV-associated TB. The intensity of any visible band on the test strip is graded by comparing it with the intensities of the bands on a manufacturer-supplied reference scale card (as shown in the example in Fig. The strip is then inspected by eye for visible bands. 2.2.3a) and incubating at room temperature for 25 minutes. The urine-based LF-LAM AlereLAM is a commercially available point-of-care test for active TB (24). AlereLAM is an immunocapture assay that detects LAM antigen in urine, LAM being a lipopolysaccharide present in mycobacterial cell walls released from metabolically active or degenerating bacterial cells during TB disease (24, 25).ĪlereLAM is performed manually by applying 60 µL of urine to the test strip (the white pad marked by the arrow symbols in Fig. This also includes children and adolescents living with HIV who are able to provide a sputum sample.ģ. These recommendations also apply to adolescents and children living with HIV, based on generalization of data from adults, while acknowledging that there are very limited data for these population groups.Ĥ. LF-LAM should be used as an add-on to clinical judgement in combination with other tests it should not be used as a replacement or triage test. Any new or generic LAM-based assay should be subject to adequate validation in the settings of intended use.Ģ. All patients with signs and symptoms of pulmonary TB who are capable of producing sputum should submit at least one sputum specimen for Xpert MTB/RIF (Ultra) assay, as their initial diagnostic test. irrespective of signs and symptoms of TB and with a CD4 cell count of less than 200 cells/mm³ ( strong recommendation, moderate certainty in the evidence about the intervention effects).Ģ. WHO suggests using LF-LAM to assist in the diagnosis of active TB in HIV-positive adults, adolescents and children:Ģ.1. with signs and symptoms of TB (pulmonary and/or extrapulmonary) or seriously ill ( conditional recommendation, low certainty in the evidence about test accuracy) andĢ.2. irrespective of signs and symptoms of TB and with a CD4 cell count of less than 100 cells/mm³ ( conditional recommendation, very low certainty in the evidence about test accuracy).ģ. WHO recommends against using LF-LAM to assist in the diagnosis of active TB in HIV-positive adults, adolescents and children:ģ.1. without assessing TB symptoms ( strong recommendation, very low certainty in the evidence about test accuracy) ģ.2. without TB symptoms and unknown CD4 cell count or without TB symptoms and CD4 cell count greater than or equal to 200 cells/mm³ ( strong recommendation, very low certainty in the evidence about test accuracy) andģ.3. without TB symptoms and with a CD4 cell count of 100-200 cells/mm³ ( conditional recommendation, very low certainty in the evidence about test accuracy).ġ. The reviewed evidence and recommendations apply to the use of AlereLAM only, because other in-house LAM-based assays have not been adequately validated or used outside limited research settings. with advanced HIV disease¹⁴ or who are seriously ill¹⁵ ( strong recommendation, moderate certainty in the evidence about the intervention effects) orġ.3. with signs and symptoms of TB (pulmonary and/or extrapulmonary) ( strong recommendation, moderate certainty in the evidence about the intervention effects) orġ.2. WHO strongly recommends using LF-LAM to assist in the diagnosis of active TB in HIV-positive adults, adolescents and children:ġ.1.
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