Tuberculosis diagnostics to reduce HIV-associated mortality

Tuberculosis (TB) was declared a global emergency in 1993 by the World health Organization (WHO), with global and African regional TB incidence rates driven by the HIV epidemic. Much of this burden lay in health facilities in sub-Saharan Africa, with post-mortem studies showing almost half of fatal TB goes undiagnosed, reflecting a failure in the approach to TB diagnostics. HIV-associated TB is often under the clinical radar, and this paper describes strategies to improve TB diagnostics to expedite treatment, reduce the amount of undiagnosed disease and ultimately reduce mortality. Through studies assessing the diagnostic accuracy and yield of new, rapid TB diagnostics, including the Xpert MTB/RIF nucleic acid amplification and urinary lipoarabinomannan (LAM) lateral flow assays, and clinical trials to measure impact on mortality and clinically relevant outcomes, this paper describes how TB diagnostics can reduce HIV-associated morbidity and mortality. With improved TB diagnostics in the pipeline, the future of urine-LAM assays for TB are also discussed.