High diagnostic yield of tuberculosis from screening urine samples from HIV-infected patients with advanced immunodeficiency using the Xpert MTB/RIF assay.

: ABSTRACT:: We determined the diagnostic yield of the Xpert MTB/RIF assay for tuberculosis (TB) when testing small volumes of urine from ambulatory HIV-infected patients prior to starting antiretroviral therapy (ART) in South Africa. Compared to a gold standard of sputum culture, the sensitivity of urine Xpert among those with CD4 cell counts of <50, 50-100 and >100 cells/?L were 44.4%, 25.0% and 2.7% (P=0.001), respectively. Urine Xpert testing provides a means of rapid TB diagnosis in patients with advanced immunodeficiency and poor prognosis. These data are indicative of high rates of TB dissemination and renal involvement in this clinical population.