The utility of urine lipoarabinomannan as a tuberculosis treatment monitoring tool in people living with HIV.

Seventy-five participants were enrolled, of whom 51 (68%) were women, and 43 (57.4%) were antiretroviral therapy naïve. CD4 cell counts were available for 49 participants with a median of 58 cells/mm³ (Interquartile range: 22-175). All participants initially tested positive for urine LAM; however, 12 (16%) converted to negative within two days of starting tuberculosis treatment. During the eight-week follow-up, 49 participants (65.3%) reverted from negative to positive at least once, primarily within the first two weeks, with notable peaks on day 4 (14, 28.6%) and day 5 (10, 20.4%). Of the 53 participants with urine LAM results at eight weeks, 26 participants (49.1%) had sustained urine LAM negativity. There was a significant LAM negativity trend from baseline to week 8 (Cochran-Armitage test for trend, p = 0.002). Urine LAM negativity did not significantly correlate with sputum smear or culture negativity (p = 0.521). These findings indicate that urine lipoarabinomannan testing is unreliable for monitoring tuberculosis treatment in people living with HIV, although repeated measurements offer insight into its performance in real-world settings.