Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study

the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium

doi:10.1002/jia2.25392

Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study

the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium

Mailman School of Public Health

Research output: Contribution to journal › Article › peer-review

27 Citations (Scopus)

Abstract

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.

Original language	English
Article number	e25392
Journal	Journal of the International AIDS Society
Volume	22
Issue number	9
DOIs	https://doi.org/10.1002/jia2.25392
Publication status	Published - Sept 1 2019

Bibliographical note

Publisher Copyright:
© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

Funding

The International Epidemiology Databases to Evaluate AIDS (IeDEA) is supported by the U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, and the National Institute on Drug Abuse: Asia-Pacific, U01AI069907; CCASAnet, U01AI069923; Central Africa, U01AI096299; East Africa, U01AI069911; NA-ACCORD, U01AI069918; Southern Africa, U01AI069924; West Africa, U01AI069919; Pettit K08 AI104352. This work is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above. We thank the sites that participated in the survey and the patients whose data were used in the study.

Funders	Funder number
IeDEA
NA-ACCORD	K08 AI104352
National Institute of Mental Health
National Institute on Drug Abuse
National Cancer Institute
National Institute of Allergy and Infectious Diseases	U01AI069919, U01AI096299, U01AI069907, U01AI069918, U01AI069923, U01AI069911, U01AI069924, K08AI104352
Eunice Kennedy Shriver National Institute of Child Health and Human Development

ASJC Scopus Subject Areas

Public Health, Environmental and Occupational Health
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/jia2.25392

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Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study. / the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium.
In: Journal of the International AIDS Society, Vol. 22, No. 9, e25392, 01.09.2019.

Research output: Contribution to journal › Article › peer-review

@article{211f6464133d45d1a7ba8459673a87ae,

title = "Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study",

abstract = "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.",

author = "{the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium} and Kathrin Z{\"u}rcher and Marie Ballif and Sasisopin Kiertiburanakul and Henri Chenal and Marcel Yotebieng and Beatriz Grinsztejn and Denna Michael and Sterling, {Timothy R.} and Ngonyani, {Kapella M.} and Mandalakas, {Anna M.} and Matthias Egger and Pettit, {April C.} and Lukas Fenner and Valdilea Veloso and Paula Luz and {de Boni}, Raquel and Wagner, {Sandra Cardoso} and Ruth Friedman and Ronaldo Moreira and Madero, {Juan Sierra} and Ramirez, {Brenda Crabtree} and Paco Belaunzaran and Vega, {Yanink Caro} and Eduardo Gotuzzo and Fernando Mejia and Gabriela Carriquiry and McGowan, {Catherine C.} and Shepherd, {Bryan E.} and Karu Jayathilake and Person, {Anna K.} and Rebeiro, {Peter F.} and Mark Giganti and Jessica Castilho and Duda, {Stephany N.} and Fernanda Maruri and Hilary Vansell and E. Uy and R. Bantique and A. vihingsanon and S. Gatechompol and P. Phanuphak and C. Phadungphon and A. Phuphuakrat and L. Chumla and N. Sanmeema and Nguyen, {K. V.} and Bui, {H. V.} and Nguyen, {D. T.H.} and Nguyen, {D. T.} and Batya Elul",

note = "Publisher Copyright: {\textcopyright} 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.",

year = "2019",

month = sep,

day = "1",

doi = "10.1002/jia2.25392",

language = "English",

volume = "22",

journal = "Journal of the International AIDS Society",

issn = "1758-2652",

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TY - JOUR

T1 - Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries

T2 - a multicohort study

AU - the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium

AU - Zürcher, Kathrin

AU - Ballif, Marie

AU - Kiertiburanakul, Sasisopin

AU - Chenal, Henri

AU - Yotebieng, Marcel

AU - Grinsztejn, Beatriz

AU - Michael, Denna

AU - Sterling, Timothy R.

AU - Ngonyani, Kapella M.

AU - Mandalakas, Anna M.

AU - Egger, Matthias

AU - Pettit, April C.

AU - Fenner, Lukas

AU - Veloso, Valdilea

AU - Luz, Paula

AU - de Boni, Raquel

AU - Wagner, Sandra Cardoso

AU - Friedman, Ruth

AU - Moreira, Ronaldo

AU - Madero, Juan Sierra

AU - Ramirez, Brenda Crabtree

AU - Belaunzaran, Paco

AU - Vega, Yanink Caro

AU - Gotuzzo, Eduardo

AU - Mejia, Fernando

AU - Carriquiry, Gabriela

AU - McGowan, Catherine C.

AU - Shepherd, Bryan E.

AU - Jayathilake, Karu

AU - Person, Anna K.

AU - Rebeiro, Peter F.

AU - Giganti, Mark

AU - Castilho, Jessica

AU - Duda, Stephany N.

AU - Maruri, Fernanda

AU - Vansell, Hilary

AU - Uy, E.

AU - Bantique, R.

AU - vihingsanon, A.

AU - Gatechompol, S.

AU - Phanuphak, P.

AU - Phadungphon, C.

AU - Phuphuakrat, A.

AU - Chumla, L.

AU - Sanmeema, N.

AU - Nguyen, K. V.

AU - Bui, H. V.

AU - Nguyen, D. T.H.

AU - Nguyen, D. T.

AU - Elul, Batya

PY - 2019/9/1

Y1 - 2019/9/1

N2 - 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.

AB - 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.

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Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study

Abstract

Bibliographical note

Funding

ASJC Scopus Subject Areas

UN SDGs

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