Extrapulmonary tuberculosis in HIV-infected patients in rural Tanzania: The prospective Kilombero and Ulanga antiretroviral cohort
| العنوان: | Extrapulmonary tuberculosis in HIV-infected patients in rural Tanzania: The prospective Kilombero and Ulanga antiretroviral cohort |
|---|---|
| المؤلفون: | 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 |
| المصدر: | PLoS ONE PLoS ONE, Vol 15, Iss 3, p e0229875 (2020) |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | 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 |
| الوصف: | 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 |
| وصف الملف: | application/pdf |
| تدمد: | 1932-6203 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::37bc6535c86d7a20e02a7fe2c0a1cb74 https://pubmed.ncbi.nlm.nih.gov/32130279 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....37bc6535c86d7a20e02a7fe2c0a1cb74 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19326203 |
|---|