Publication:
Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study

Issued Date

2019-09-01

Resource Type

Article

ISSN

17582652

DOI

10.1002/jia2.25392

Other identifier(s)

2-s2.0-85072020531

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Journal of the International AIDS Society. Vol.22, No.9 (2019)

Suggested Citation

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 Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study. Journal of the International AIDS Society. Vol.22, No.9 (2019). doi:10.1002/jia2.25392 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/51450

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Thesis

Title

Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study

Author(s)

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

Other Contributor(s)

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)

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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/51450

Collections

Scopus 2019