Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study.
HIV-positive patients
diagnostics
extrapulmonary tuberculosis
lost to follow-up
low- and middle-income countries
mortality
pulmonary tuberculosis
tuberculosis
Journal
Journal of the International AIDS Society
ISSN: 1758-2652
Titre abrégé: J Int AIDS Soc
Pays: Switzerland
ID NLM: 101478566
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
22
01
2019
accepted:
09
08
2019
entrez:
12
9
2019
pubmed:
12
9
2019
medline:
14
7
2020
Statut:
ppublish
Résumé
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). 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. 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. 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.
Identifiants
pubmed: 31507083
doi: 10.1002/jia2.25392
pmc: PMC6737289
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25392Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR000445
Pays : United States
Organisme : NIAID NIH HHS
ID : K08 AI104352
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069923
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069911
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069919
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069907
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069924
Pays : United States
Investigateurs
Valdilea Veloso
(V)
Paula Luz
(P)
Raquel de Boni
(R)
Sandra Cardoso Wagner
(SC)
Ruth Friedman
(R)
Ronaldo Moreira
(R)
Juan Sierra Madero
(JS)
Brenda Crabtree Ramirez
(BC)
Paco Belaunzaran
(P)
Yanink Caro Vega
(YC)
Eduardo Gotuzzo
(E)
Fernando Mejia
(F)
Gabriela Carriquiry
(G)
Catherine C McGowan
(CC)
Bryan E Shepherd
(BE)
Timothy Sterling
(T)
Karu Jayathilake
(K)
Anna K Person
(AK)
Peter F Rebeiro
(PF)
Mark Giganti
(M)
Jessica Castilho
(J)
Stephany N Duda
(SN)
Fernanda Maruri
(F)
Hilary Vansell
(H)
E Uy
(E)
R Bantique
(R)
A Vihingsanon
(A)
S Gatechompol
(S)
P Phanuphak
(P)
C Phadungphon
(C)
S Kiertiburanakul
(S)
A Phuphuakrat
(A)
L Chumla
(L)
N Sanmeema
(N)
K V Nguyen
(KV)
H V Bui
(HV)
Dth Nguyen
(D)
D T Nguyen
(DT)
D D Cuong
(DD)
N V An
(NV)
N T Luan
(NT)
A H Sohn
(AH)
J L Ross
(JL)
B Petersen
(B)
D A Cooper
(DA)
M G Law
(MG)
A Jiamsakul
(A)
D C Boettiger
(DC)
John Ssali
(J)
Mathew Ssemakadde
(M)
Kapella Ngonyani
(K)
Jerome Lwali
(J)
Mark Urassa
(M)
Richard Machemba
(R)
Kara Wools-Kaloustian
(K)
Constantin Yiannoutsos
(C)
Rachel Vreeman
(R)
Beverly Musick
(B)
Batya Elul
(B)
Rami Kantor
(R)
Jeffrey Martin
(J)
Megan Wenger
(M)
Craig Cohen
(C)
Jayne Kulzer
(J)
Djimon Marcel Zannou
(DM)
Angèle Azon-Kouanou
(A)
Hamar Alassane Traore
(HA)
Daouda Minta
(D)
Amadou Abathina Toure
(AA)
Moussa Seydi
(M)
Coumba Cissé Bassabi
(CC)
François Dabis
(F)
Emmanuel Bissagnene
(E)
Elise Arrivé
(E)
Patrick Coffie
(P)
Didier Ekouevi
(D)
Antoine Jaquet
(A)
Valériane Leroy
(V)
Charlotte Lewden
(C)
Annie J Sasco
(AJ)
Dieudonné Amani
(D)
Jean-Claude Azani
(JC)
Eric Balestre
(E)
Serge Bessekon
(S)
Franck Bohossou
(F)
Camille Gilbert
(C)
Sophie Karcher
(S)
Jules Mahan Gonsan
(JM)
Jérôme Le Carrou
(J)
Séverin Lenaud
(S)
Célestin Nchot
(C)
Karen Malateste
(K)
Amon Roseamonde Yao
(AR)
Bertine Siloué
(B)
Gwenaelle Clouet
(G)
Madikona Dosso
(M)
Alexandra Doring
(A)
Adrienne Kouakou
(A)
Elodie Rabourdin
(E)
Jean Rivenc
(J)
Xavier Anglaret
(X)
Boubacar Ba
(B)
Andrea Ciaranello
(A)
Sébastien Datté
(S)
Sophie Desmonde
(S)
Jean-Serge Elvis Diby
(JS)
Geoffrey S Gottlieb
(GS)
Serge N'zoré Kangah
(SN)
Denis Malvy
(D)
David Meless
(D)
Aida Mounkaila-Harouna
(A)
Camille Ndondoki
(C)
Boris Tchounga
(B)
Rodolphe Thiébaut
(R)
Gilles Wandeler
(G)
Jean Claude Dusingize
(JC)
Eugene Mutimura
(E)
Eugene Mutimura
(E)
Judy Tatwangire
(J)
Izimukwiye Izabelle
(I)
Evelyne Baramperanye
(E)
Andrew Edmonds
(A)
Innocent Azinyue
(I)
Liliane Ayangma
(L)
Informations de copyright
© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
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