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DIAGNOSIS AND CLINICAL OUTCOMES OF EXTRAPULMONARY TUBERCULOSIS IN ANTIRETROVIRAL THERAPY PROGRAMMES IN LOW- AND MIDDLE-INCOME COUNTRIES: A MULTICOHORT STUDY
Pulmonary tuberculosis
Tuberculosis
HIV-positive patients
Low- and middle-income countries
Diagnostics
Mortality
Lost to follow-up
Autor
Afiliación
University of Bern. Institute of Social and Preventive Medicine. Bern, Switzerland.
University of Bern. Institute of Social and Preventive Medicine. Bern, Switzerland.
Mahidol University. Faculty of Medicine. Ramathibodi Hospital. Bangkok, Thailand.
Centre Intégré de Recherches Biocliniques d’Abidjan. Abidjan, Cotê d’Ivoire.
Ohio State University. College of Public Health. Columbus, OH, USA
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
National Institute for Medical Research, Kisesa HDSS. Mwanza, Tanzania.
Vanderbilt Tuberculosis Center. Nashville, TN, USA / Vanderbilt University Medical Center. Division of Infectious Diseases. Nashville, TN, USA.
Tumbi Special Hospital, CTC, Kibaha Town, Tanzania
Baylor College of Medicine. Global Tuberculosis Program. Houston, TX, USA / Texas Children’s Hospital. Houston, TX, USA.
University of Bern. Institute of Social and Preventive Medicine. Bern, Switzerland / University of Cape Town. School of Public Health & Family Medicine. Centre for Infectious Disease Epidemiology & Research. Cape Town, South Africa.
Vanderbilt Tuberculosis Center. Nashville, TN, USA / Vanderbilt University Medical Center. Division of Infectious Diseases. Nashville, TN, USA.
University of Bern. Institute of Social and Preventive Medicine. Bern, Switzerland.
University of Bern. Institute of Social and Preventive Medicine. Bern, Switzerland.
Mahidol University. Faculty of Medicine. Ramathibodi Hospital. Bangkok, Thailand.
Centre Intégré de Recherches Biocliniques d’Abidjan. Abidjan, Cotê d’Ivoire.
Ohio State University. College of Public Health. Columbus, OH, USA
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
National Institute for Medical Research, Kisesa HDSS. Mwanza, Tanzania.
Vanderbilt Tuberculosis Center. Nashville, TN, USA / Vanderbilt University Medical Center. Division of Infectious Diseases. Nashville, TN, USA.
Tumbi Special Hospital, CTC, Kibaha Town, Tanzania
Baylor College of Medicine. Global Tuberculosis Program. Houston, TX, USA / Texas Children’s Hospital. Houston, TX, USA.
University of Bern. Institute of Social and Preventive Medicine. Bern, Switzerland / University of Cape Town. School of Public Health & Family Medicine. Centre for Infectious Disease Epidemiology & Research. Cape Town, South Africa.
Vanderbilt Tuberculosis Center. Nashville, TN, USA / Vanderbilt University Medical Center. Division of Infectious Diseases. Nashville, TN, USA.
University of Bern. Institute of Social and Preventive Medicine. Bern, Switzerland.
Resumen en ingles
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/lL (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.
Palabras clave en ingles
Extrapulmonary tuberculosisPulmonary tuberculosis
Tuberculosis
HIV-positive patients
Low- and middle-income countries
Diagnostics
Mortality
Lost to follow-up
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