Table 3.

Implications of lipoarabinomannan (LAM) antigenuria being a consequence of disseminated renal

Issue	Implications	References
Targeting the assay to appropriate patient groups	LAM assays should be prioritised for testing sick HIV-positive adults, such as those requiring acute hospital admission rather than ambulatory out-patients Interpretation of urine-LAM results requires knowledge of HIV status There are no data showing utility for testing in children	Nakiyingi et al. 201430
Design of diagnostic accuracy studies	The reference standard for disseminated TB requires testing more than one specimen type, a single sputum culture is inadequate Ideally this would include mycobacterial blood cultures and/or urine Xpert MTB/RIF assay testing	Lawn et al. 201541
Design of studies to assess incremental diagnostic yield of urine-LAM testing	Should include patients both with and without respiratory symptoms	Lawn et al. 201446
Studies of clinical impact of Urine-LAM testing	Studies should focus on acute HIV-positive medical admissions in whom undiagnosed TB and mycobacteraemia is common. e.g. LAMRCT and STAMP trials42,43	Gupta et al. 20154
		Lawn & Kerkhoff 201531
Patients testing LAM-positive have poorer prognosis than those testing LAM-negative	Patients testing urine-LAM-positive are much sicker and have poorer prognostic characteristics compared with those with TB who testing LAM-negative	Manabe et al. 201428
		Lawn et al. 201336