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
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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