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Title: Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study
Authors: Kathrin Zürcher
Marie Ballif
Sasisopin Kiertiburanakul
Henri Chenal
Marcel Yotebieng
Beatriz Grinsztejn
Denna Michael
Timothy R. Sterling
Kapella M. Ngonyani
Anna M. Mandalakas
Matthias Egger
April C. Pettit
Lukas Fenner
Valdilea Veloso
Paula Luz
Raquel de Boni
Sandra Cardoso Wagner
Ruth Friedman
Ronaldo Moreira
Juan Sierra Madero
Brenda Crabtree Ramirez
Paco Belaunzaran
Yanink Caro Vega
Eduardo Gotuzzo
Fernando Mejia
Gabriela Carriquiry
Catherine C. McGowan
Bryan E. Shepherd
Karu Jayathilake
Anna K. Person
Peter F. Rebeiro
Mark Giganti
Jessica Castilho
Stephany N. Duda
Fernanda Maruri
Hilary Vansell
E. Uy
R. Bantique
A. vihingsanon
S. Gatechompol
P. Phanuphak
C. Phadungphon
S. Kiertiburanakul
A. Phuphuakrat
L. Chumla
N. Sanmeema
K. V. Nguyen
H. V. Bui
D. T.H. Nguyen
D. T. Nguyen
D. D. Cuong
N. V. An
N. T. Luan
A. H. Sohn
J. L. Ross
B. Petersen
D. A. Cooper
M. G. Law
A. Jiamsakul
D. C. Boettiger
John Ssali
Mathew Ssemakadde
Kapella Ngonyani
Jerome Lwali
Mark Urassa
Richard Machemba
Kara Wools-Kaloustian
Constantin Yiannoutsos
Rachel Vreeman
Beverly Musick
Batya Elul
Rami Kantor
Jeffrey Martin
Megan Wenger
Craig Cohen
Jayne Kulzer
Djimon Marcel Zannou
Angèle Azon-Kouanou
Hamar Alassane Traore
Daouda Minta
Amadou Abathina Toure
Moussa Seydi
Coumba Cissé Bassabi
François Dabis
Emmanuel Bissagnene
Elise Arrivé
Patrick Coffie
Didier Ekouevi
Antoine Jaquet
Valériane Leroy
Charlotte Lewden
Annie J. Sasco
Dieudonné Amani
Jean Claude Azani
Eric Balestre
Serge Bessekon
Franck Bohossou
Camille Gilbert
Sophie Karcher
Institut fur Sozial- und Praventivmedizin
National Institute for Medical Research Tanga
Vanderbilt University Medical Center
Fundacao Oswaldo Cruz
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Vanderbilt University
Ohio State University
Baylor College of Medicine
University of Cape Town
Tumbi Special Hospital
Centre Intégré de Recherches Biocliniques d'Abidjan (CIRBA)
Keywords: Medicine
Issue Date: 1-Sep-2019
Citation: Journal of the International AIDS Society. Vol.22, No.9 (2019)
Abstract: © 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. Introduction: Extrapulmonary tuberculosis (EPTB) is difficult to confirm bacteriologically and requires specific diagnostic capacities. Diagnosis can be especially challenging in under-resourced settings. We studied diagnostic modalities and clinical outcomes of EPTB compared to pulmonary tuberculosis (PTB) among HIV-positive adults in antiretroviral therapy (ART) programmes in low- and middle-income countries (LMIC). Methods: We collected data from HIV-positive TB patients (≥16 years) in 22 ART programmes participating in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in sub-Saharan Africa, Asia-Pacific, and Caribbean, Central and South America regions between 2012 and 2014. We categorized TB as PTB or EPTB (EPTB included mixed PTB/EPTB). We used multivariable logistic regression to assess associations with clinical outcomes. Results and Discussion: We analysed 2695 HIV-positive TB patients. Median age was 36 years (interquartile range (IQR) 30 to 43), 1102 were female (41%), and the median CD4 count at TB treatment start was 114 cells/μL (IQR 40 to 248). Overall, 1930 had PTB (72%), and 765 EPTB (28%). Among EPTB patients, the most frequently involved sites were the lymph nodes (24%), pleura (15%), abdomen (11%) and meninges (6%). The majority of PTB (1123 of 1930, 58%) and EPTB (582 of 765, 76%) patients were diagnosed based on clinical criteria. Bacteriological confirmation (using positive smear microscopy, culture, Xpert MTB/RIF, or other nucleic acid amplification tests result) was obtained in 897 of 1557 PTB (52%) and 183 of 438 EPTB (42%) patients. EPTB was not associated with higher mortality compared to PTB (adjusted odd ratio (aOR) 1.0, 95% CI 0.8 to 1.3), but TB meningitis was (aOR 1.9, 95% CI 1.0 to 3.1). Bacteriological confirmation was associated with reduced mortality among PTB patients (aOR 0.7, 95% CI 0.6 to 0.8) and EPTB patients (aOR 0.3 95% CI 0.1 to 0.8) compared to TB patients with a negative test result. Conclusions: Diagnosis of EPTB and PTB at ART programmes in LMIC was mainly based on clinical criteria. Greater availability and usage of TB diagnostic tests would improve the diagnosis and clinical outcomes of both EPTB and PTB.
ISSN: 17582652
Appears in Collections:Scopus 2019

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