HIV-associated extrapulmonary tuberculosis in Thailand: epidemiology and risk factors for death.
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.
Kingkaew
Nara
N
Vachira Hospital, Phuket, Thailand.
Sangtong
Burachat
B
Amnuaiphon
Waraya
W
Jongpaibulpatana
Jessada
J
Mankatittham
Wiroj
W
Akksilp
Somsak
S
Sirinak
Chawin
C
Nateniyom
Sriprapa
S
Burapat
Channawong
C
Kittikraisak
Wanitchaya
W
Monkongdee
Patama
P
Varma
Jay K
JK
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
D019380:Anti-HIV Agents; D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D015725:Fluconazole