title: HIV-associated extrapulmonary tuberculosis in Thailand: epidemiology and risk factors for death.
abstract: BACKGROUND
  We conducted a prospective, multicenter observational cohort study in Thailand to characterize the epidemiology of extrapulmonary tuberculosis (TB) in HIV-infected persons and to identify risk factors for death.
  
  
  METHODS
  From May 2005 to September 2006, we enrolled, interviewed, examined, and performed laboratory tests on HIV-infected adult TB patients and followed them from TB treatment initiation until the end of TB treatment. We conducted multivariate proportional hazards analysis to identify factors associated with death.
  
  
  RESULTS
  Of the 769 patients, pulmonary TB only was diagnosed in 461 (60%), both pulmonary and extrapulmonary TB in 78 (10%), extrapulmonary TB at one site in 223 (29%), and extrapulmonary TB at more than one site in seven (1%) patients. Death during TB treatment occurred in 59 of 308 patients (19%) with any extrapulmonary involvement. In a proportional hazards model, patients with extrapulmonary TB had an increased risk of death if they had meningitis, and a CD4+ T-lymphocyte count <200 cells/microl. Patients who received co-trimoxazole, fluconazole, and antiretroviral therapy during TB treatment had a lower risk of death.
  
  
  CONCLUSIONS
  Among HIV-infected patients with TB, extrapulmonary disease occurred in 40% of the patients, particularly in those with advanced immune suppression. Death during TB treatment was common, but the risk of death was reduced in patients who took co-trimoxazole, fluconazole, and antiretroviral therapy.
authors.affiliation: Vachira Hospital, Phuket, Thailand.
authors.forename: Nara
authors.initials: N
authors.lastname: Kingkaew
authors.forename: Burachat
authors.initials: B
authors.lastname: Sangtong
authors.forename: Waraya
authors.initials: W
authors.lastname: Amnuaiphon
authors.forename: Jessada
authors.initials: J
authors.lastname: Jongpaibulpatana
authors.forename: Wiroj
authors.initials: W
authors.lastname: Mankatittham
authors.forename: Somsak
authors.initials: S
authors.lastname: Akksilp
authors.forename: Chawin
authors.initials: C
authors.lastname: Sirinak
authors.forename: Sriprapa
authors.initials: S
authors.lastname: Nateniyom
authors.forename: Channawong
authors.initials: C
authors.lastname: Burapat
authors.forename: Wanitchaya
authors.initials: W
authors.lastname: Kittikraisak
authors.forename: Patama
authors.initials: P
authors.lastname: Monkongdee
authors.forename: Jay K
authors.initials: JK
authors.lastname: Varma
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013785:Thailand / Q000453:epidemiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D015725:Fluconazole