Kathrin ZürcherMarie BallifSasisopin KiertiburanakulHenri ChenalMarcel YotebiengBeatriz GrinsztejnDenna MichaelTimothy R. SterlingKapella M. NgonyaniAnna M. MandalakasMatthias EggerApril C. PettitLukas FennerValdilea VelosoPaula LuzRaquel de BoniSandra Cardoso WagnerRuth FriedmanRonaldo MoreiraJuan Sierra MaderoBrenda Crabtree RamirezPaco BelaunzaranYanink Caro VegaEduardo GotuzzoFernando MejiaGabriela CarriquiryCatherine C. McGowanBryan E. ShepherdKaru JayathilakeAnna K. PersonPeter F. RebeiroMark GigantiJessica CastilhoStephany N. DudaFernanda MaruriHilary VansellE. UyR. BantiqueA. vihingsanonS. GatechompolP. PhanuphakC. PhadungphonS. KiertiburanakulA. PhuphuakratL. ChumlaN. SanmeemaK. V. NguyenH. V. BuiD. T.H. NguyenD. T. NguyenD. D. CuongN. V. AnN. T. LuanA. H. SohnJ. L. RossB. PetersenD. A. CooperM. G. LawA. JiamsakulD. C. BoettigerJohn SsaliMathew SsemakaddeKapella NgonyaniJerome LwaliMark UrassaRichard MachembaKara Wools-KaloustianConstantin YiannoutsosRachel VreemanBeverly MusickBatya ElulRami KantorJeffrey MartinMegan WengerCraig CohenJayne KulzerDjimon Marcel ZannouAngèle Azon-KouanouHamar Alassane TraoreDaouda MintaAmadou Abathina ToureMoussa SeydiCoumba Cissé BassabiFrançois DabisEmmanuel BissagneneElise ArrivéPatrick CoffieDidier EkoueviAntoine JaquetValériane LeroyCharlotte LewdenAnnie J. SascoDieudonné AmaniJean Claude AzaniEric BalestreSerge BessekonFranck BohossouCamille GilbertSophie KarcherInstitut fur Sozial- und PraventivmedizinNational Institute for Medical Research TangaVanderbilt University Medical CenterFundacao Oswaldo CruzFaculty of Medicine, Ramathibodi Hospital, Mahidol UniversityVanderbilt UniversityOhio State UniversityBaylor College of MedicineUniversity of Cape TownTumbi Special HospitalCentre Intégré de Recherches Biocliniques d'Abidjan (CIRBA)2020-01-272020-01-272019-09-01Journal of the International AIDS Society. Vol.22, No.9 (2019)175826522-s2.0-85072020531https://repository.li.mahidol.ac.th/handle/20.500.14594/51450© 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.Mahidol UniversityMedicineArticleSCOPUS10.1002/jia2.25392