Urinary Lipoarabinomannan Detection and Disseminated Nontuberculous Mycobacterial Disease

To the Editor—We read with interest Nel and colleagues' article, "Does disseminated nontuberculous mycobacterial disease cause false-positive Determine TB-LAM lateral flow assay results? A retrospective review" [1]. The authors present an important finding relevant to clinicians who manage patients with advanced human immunodeficiency virus (HIV). Although we agree that disseminated nontuberculous mycobacterial (NTM) disease needs to be considered in patients with positive Determine TB-LAM lateral flow assay (LF-LAM) results, we urge that the implications for clinical practice be considered in the context of what is known about the relative incidence of tuberculosis and NTM disease in high HIV burden settings. Disseminated NTM disease is almost exclusively observed in patients with extreme immunosuppression (median CD4 count consistently <50 cells/μL, often <10 cells/μL) [2], has always been uncommon in HIV-infected patients in Africa, and has become more rare in the era of combination antiretroviral therapy (ART).