Extrapulmonary tuberculosis in HIV-infected patients in rural Tanzania: The prospective Kilombero and Ulanga antiretroviral cohort
Autor: | Tracy R. Glass, Robert Ndege, Martin Rohacek, Jerry Hella, George Sikalengo, Manuel Battegay, Fabian C. Franzeck, Klaus Reither, Maja Weisser, Dorcas Mnzava, Farida Bani, Armon Arpagaus, Omary Ngome Rajab, Daniel H. Paris |
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Rok vydání: | 2019 |
Předmět: |
0301 basic medicine
Male Rural Population Bacterial Diseases RNA viruses Physiology HIV Infections Pathology and Laboratory Medicine Tanzania Nervous System Geographical Locations 0302 clinical medicine Immunodeficiency Viruses Interquartile range Risk Factors Epidemiology Medicine and Health Sciences 030212 general & internal medicine Prospective Studies Prospective cohort study Cerebrospinal Fluid Multidisciplinary Mortality rate Incidence (epidemiology) Hazard ratio Middle Aged Body Fluids Infectious Diseases Anti-Retroviral Agents Medical Microbiology Viral Pathogens Cohort Viruses Medicine Tuberculosis Diagnosis and Management Female Anatomy Pathogens Research Article Adult medicine.medical_specialty Tuberculosis Clinical Pathology Death Rates Science 030106 microbiology Microbiology 03 medical and health sciences Population Metrics Diagnostic Medicine Internal medicine Retroviruses medicine Humans Tuberculosis Pulmonary Microbial Pathogens Population Biology business.industry Lentivirus Organisms Sputum Biology and Life Sciences HIV Mycobacterium tuberculosis medicine.disease Tropical Diseases Clinical Microbiology Mucus People and Places Africa business |
Zdroj: | PLoS ONE PLoS ONE, Vol 15, Iss 3, p e0229875 (2020) |
ISSN: | 1932-6203 |
Popis: | Background In sub-Saharan Africa, diagnosis and management of extrapulmonary tuberculosis (EPTB) in people living with HIV (PLHIV) remains a major challenge. This study aimed to characterize the epidemiology and risk factors for poor outcome of extrapulmonary tuberculosis in people living with HIV (PLHIV) in a rural setting in Tanzania. Methods We included PLHIV >18 years of age enrolled into the Kilombero and Ulanga antiretroviral cohort (KIULARCO) from 2013 to 2017. We assessed the diagnosis of tuberculosis by integrating prospectively collected clinical and microbiological data. We calculated prevalence- and incidence rates and used Cox regression analysis to evaluate the association of risk factors in extrapulmonary tuberculosis (EPTB) with a combined endpoint of lost to follow-up (LTFU) and death. Results We included 3,129 subjects (64.5% female) with a median age of 38 years (interquartile range [IQR] 31–46) and a median CD4+ cell count of 229/μl (IQR 94–421) at baseline. During the median follow-up of 1.25 years (IQR 0.46–2.85), 574 (18.4%) subjects were diagnosed with tuberculosis, whereof 175 (30.5%) had an extrapulmonary manifestation. Microbiological evidence by Acid-Fast-Bacillus stain (AFB-stain) or Xpert® MTB/RIF was present in 178/483 (36.9%) patients with pulmonary and in 28/175 (16.0%) of patients with extrapulmonary manifestations, respectively. Incidence density rates for pulmonary Tuberculosis (PTB and EPTB were 17.9/1000person-years (py) (95% CI 14.2–22.6) and 5.8/1000 py (95% CI 4.0–8.5), respectively. The combined endpoint of death and LTFU was observed in 1058 (33.8%) patients, most frequently in the subgroup of EPTB (47.2%). Patients with EPTB had a higher rate of the composite outcome of death/LTFU after TB diagnosis than with PTB [HR 1.63, (1.14–2.31); p = 0.006]. The adjusted hazard ratios [HR (95% CI)] for death/LTFU in EPTB patients were significantly increased for patients aged >45 years [HR 1.95, (1.15–3.3); p = 0.013], whereas ART use was protective [HR 0.15, (0.08–0.27); p |
Databáze: | OpenAIRE |
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