LF-LAM UPDATE Assey, 2021

Ermias T.
 LF-LAM UPDATE
• WHO-approved nationally recommended rapid tests
for diagnosis of TB and DR-TB Rapid and sensitive
molecular tests have become available to replace or
complement existing conventional tests for
detecting MTBC and drug resistance recently.
• The National TBL Control Program recommends that
these rapid techniques be used as the initial
diagnostic test to detect MTBC and RIF resistance, to
minimize delays in starting appropriate treatment.
The following rapid molecular diagnostic tests
are currently recommended for use in Ethiopia.
1. Xpert® MTB/ RIF and Xpert MTB/RIF Ultra assays
2. Truenat™ MTB, MTB Plus and MTBRIF Dx tests
3. Line-probe assays (LPAs): GenoType® MTBDRplus
and GenoType® MTBDRsl)
4. Lateral flow lipoarabinomannan assay (LF-LAM)
test to assist in diagnosing TB in selected groups of
HIV-infected presumed TB patients.
5. Loop-mediated isothermal amplification (TB-
LAMP)
 Urine LF-LAM assay
• The urine LF-LAM assay is an immunocapture assay
based on the detection of the mycobacterial LAM
antigen in urine, and is a potential point-of-care test
for certain populations being evaluated for TB.
Although the assay lacks sensitivity, it can be used as
a fast, bedside, rule-in test for HIV-positive
individuals, especially in urgent cases where a rapid
TB diagnosis is critical for the patient’s survival.
• The detection of mycobacterial LAM antigen in urine
does not provide any information on drug resistance.
The urine LF-LAM test is recommended for use
in the following situations:
• Inpatients: LF-LAM is recommended to assist in the diagnosis of
active TB in HIV-positive adults, adolescents and children with signs
and symptoms of TB with advanced HIV disease or who are seriously
ill, or with a CD4 cell count of less than 200 cells/mm3, irrespective
of signs and symptoms of TB.
• Outpatients: LF-LAM is recommended to assist in the diagnosis of
active TB in HIV positive adults, adolescents and children who: have
signs and symptoms of TB; are seriously ill; or have a CD4 cell count
of less than 100 cells/mm3 irrespective of signs and symptoms of TB.
• It is not recommended to use LF-LAM to assist in the diagnosis of
active TB in HIV-positive adults, adolescents and children without TB
symptoms and with an unknown CD4 cell count, or with a CD4 cell
count greater than 100 cells/mm3
 Continue….
• For their initial diagnostic test, all patients with signs and
symptoms of pulmonary TB who are capable of producing
sputum should have at least one sputum specimen submitted
for a molecular WRD assay. This also includes children and
adolescents living with HIV who are able to provide a sputum
sample.
• LF-LAM results (test time < 15 minutes) are likely to be
available before molecular WRD test results; hence,
treatment decisions should be based on the LF-LAM result
while awaiting the results of other diagnostic tests.
• 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
Thank You