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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
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, Volume 22, No. 9, Article e25392, Year 2019
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Description
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. © 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
Authors & Co-Authors
Zürcher, Kathrin
Switzerland, Bern
University of Bern
Ballif, Marie
Switzerland, Bern
University of Bern
Kiertiburanakul, Sasisopin
Thailand, Nakhon Pathom
Mahidol University
Chenal, Henri
Cote D'ivoire, Abidjan
Centre Intégré de Recherches Biocliniques D'abidjan Cirba
Yotebieng, Marcel
United States, Columbus
The Ohio State University
Grinsztejn, Beatriz Gilda Jegerhorn
Brazil, Rio de Janeiro
Fundacao Oswaldo Cruz
Michael, Denna
Tanzania, Tanga
National Institute for Medical Research Tanga
Sterling, Timothy R.
United States, Nashville
Vanderbilt University Medical Center
Ngonyani, Kapella M.
Tanzania, Kibaha Town
Tumbi Special Hospital
Mandalakas, A. M.
United States, Houston
Texas Children's Hospital
Egger, Matthias
Switzerland, Bern
University of Bern
South Africa, Cape Town
University of Cape Town
Pettit, April C.
United States, Nashville
Vanderbilt University Medical Center
Fenner, Lukas
Switzerland, Bern
University of Bern
Veloso, Valdileá Gonçalves
Unknown Affiliation
Luz, Paula Mendes
Unknown Affiliation
De Boni, Raquel B.
Unknown Affiliation
Wagner, Sandra Cardoso
Unknown Affiliation
Friedman, Ruth Khalili
Unknown Affiliation
Moreira, Ronaldo Ismério
Unknown Affiliation
Madero, Juan Sierra
Unknown Affiliation
Ramirez, Brenda Crabtree
Unknown Affiliation
Belaunzarán-Zamudio, Pablo F.
Unknown Affiliation
Vega, Yanink Caro
Unknown Affiliation
Gotuzzo, Eduardo H.
Unknown Affiliation
Mejía, Fernando A.
Unknown Affiliation
Carriquiry, Gabriela
Unknown Affiliation
McGowan, Catherine Carey
Unknown Affiliation
Shepherd, Bryan Earl
Unknown Affiliation
Jayathilake, Karu
Unknown Affiliation
Person, Anna Kristine
Unknown Affiliation
Rebeiro, Peter F.
Unknown Affiliation
Giganti, Mark Joseph
Unknown Affiliation
Castilho, Jessica L.
Unknown Affiliation
Duda, Stephany N.
Unknown Affiliation
Maruri, Fernanda
Unknown Affiliation
Vansell, Hilary J.
Unknown Affiliation
Uy, Eirene
Unknown Affiliation
Bantique, R. O.
Unknown Affiliation
Vihingsanon, A.
Unknown Affiliation
Gatechompol, Sivaporn
Unknown Affiliation
Phanuphak, Praphan
Unknown Affiliation
Phadungphon, Chowalit
Unknown Affiliation
Phuphuakrat, Angsana
Unknown Affiliation
Chumla, L.
Unknown Affiliation
Sanmeema, Nutaporn
Unknown Affiliation
Nguyen, Kinh Van
Unknown Affiliation
Bui, Huy Vu
Unknown Affiliation
Nguyen, Duong Thuy H.
Unknown Affiliation
Nguyen, Dung Thi Hoai
Unknown Affiliation
Cuong, Do Duy
Unknown Affiliation
An, N. V.
Unknown Affiliation
Luan, N. T.
Unknown Affiliation
Sohn, Annette H.
Unknown Affiliation
Ross, Jeremy L.
Unknown Affiliation
Petersen, Boondarika
Unknown Affiliation
Cooper, David A.
Unknown Affiliation
Law, Matthew G.
Unknown Affiliation
Jiamsakul, Awachana
Unknown Affiliation
Boettiger, David C.
Unknown Affiliation
Ssali, John C.
Unknown Affiliation
Ssemakadde, Matthew
Unknown Affiliation
Ngonyani, Kapella Zacharia
Unknown Affiliation
Lwali, Jerome
Unknown Affiliation
Urassa, Mark S.
Unknown Affiliation
Machemba, Richard
Unknown Affiliation
Wools-Kaloustian, Kara K.
Unknown Affiliation
Yiannoutsos, Constantin T.
Unknown Affiliation
Vreeman, Rachel Christine
Unknown Affiliation
Musick, Beverly Sue
Unknown Affiliation
Elul, Batya
Unknown Affiliation
Kantor, Rami
Unknown Affiliation
Martin, Jeffrey N.
Unknown Affiliation
Wenger, Megan A.
Unknown Affiliation
Cohen, Craig R.
Unknown Affiliation
Lewis-Kulzer, Jayne
Unknown Affiliation
Zannou, Djimon Marcel
Unknown Affiliation
Azon-Kouanou, Angèle
Unknown Affiliation
Traoré, Hammar Alassane
Unknown Affiliation
Minta, Daouada K.
Unknown Affiliation
Touré, Amadou Abathina
Unknown Affiliation
Seydi, Moussa
Unknown Affiliation
Bassabi, Coumba Cissé
Unknown Affiliation
Dabis, Franćois Ç.Ois
Unknown Affiliation
Bissagnéné, Emmanuel
Unknown Affiliation
Arrivé, Élise
Unknown Affiliation
Coffié, Patrick Ahuatchi
Unknown Affiliation
Ékouévi, Didier Koumavi
Unknown Affiliation
Jaquet, Antoine
Unknown Affiliation
Leroy, Valeriane
Unknown Affiliation
Lewden, Charlotte
Unknown Affiliation
Sasco, Annie Jeanne
Unknown Affiliation
Amani, Dieudonné
Unknown Affiliation
Azani, Jean Claude
Unknown Affiliation
Balestre, Eric
Unknown Affiliation
Bessekon, Serge
Unknown Affiliation
Bohossou, Franck
Unknown Affiliation
Gilbert, Camille
Unknown Affiliation
Karcher, Sophie
Unknown Affiliation
Gonsan, Jules Mahan
Unknown Affiliation
Le Carrou, Jérôme
Unknown Affiliation
Lenaud, Sêverin
Unknown Affiliation
Nchot, Célestin
Unknown Affiliation
Malateste, Karen
Unknown Affiliation
Siloué, Bertine
Unknown Affiliation
Doring, Alexandra
Unknown Affiliation
Kouakou, Adrienne V.
Unknown Affiliation
Rabourdin, Elodie
Unknown Affiliation
Anglaret, Xavier
Unknown Affiliation
Ba, Boubacar
Unknown Affiliation
Ciaranello, Andrea L.
Unknown Affiliation
Datté, Sébastien Atta
Unknown Affiliation
Desmonde, Sophie
Unknown Affiliation
Malvy, Denis Jean Marie
Unknown Affiliation
Meless, David Guanga
Unknown Affiliation
Mounkaila-Harouna, Aïda
Unknown Affiliation
Ndondoki, Camille
Unknown Affiliation
Tchounga, Boris Kévin
Unknown Affiliation
Thíébaut, Rodolphe
Unknown Affiliation
Wandeler, Gilles
Unknown Affiliation
Dusingize, Jean Claude
Unknown Affiliation
Mutimura, Eugene
Unknown Affiliation
Baramperanye, Evelyne
Unknown Affiliation
Edmonds, Andrew
Unknown Affiliation
Azinyue, Innocent
Unknown Affiliation
Ayangma, Liliane
Unknown Affiliation
Statistics
Citations: 22
Authors: 125
Affiliations: 10
Identifiers
Doi:
10.1002/jia2.25392
ISSN:
17582652
Research Areas
Infectious Diseases
Participants Gender
Female