title: Site of extrapulmonary tuberculosis is associated with HIV infection.
abstract: BACKGROUND
  In the United States, the proportion of patients with extrapulmonary tuberculosis (EPTB) has increased relative to cases of pulmonary tuberculosis. Patients with central nervous system (CNS)/meningeal and disseminated EPTB and those with human immunodeficiency virus (HIV)/AIDS have increased mortality. The purpose of our study was to determine risk factors associated with particular types of EPTB.
  
  
  METHODS
  We retrospectively reviewed 320 cases of EPTB from 1995-2007 at a single urban US public hospital. Medical records were reviewed to determine site of EPTB and patient demographic and clinical characteristics. Multivariable logistic regression analyses were performed to determine independent associations between patient characteristics and site of disease.
  
  
  RESULTS
  Patients were predominantly male (67%), African American (82%), and US-born (76%). Mean age was 40 years (range 18-89). The most common sites of EPTB were lymphatic (28%), disseminated (23%), and CNS/meningeal (22%) disease. One hundred fifty-four (48.1%) were HIV-infected, 40% had concomitant pulmonary tuberculosis, and 14.7% died within 12 months of EPTB diagnosis. Multivariable analysis demonstrated that HIV-infected patients were less likely to have pleural (adjusted odds ratio [AOR] 0.3; 95% confidence interval [CI] .2, .6) as site of EPTB disease than HIV-uninfected patients. Among patients with EPTB and HIV-infection, patients with CD4 lymphocyte cell count <100 were more likely to have severe forms of EPTB (CNS/meningeal and/or disseminated) (AOR 1.6; 95% CI, 1.0, 2.4).
  
  
  CONCLUSIONS
  Among patients hospitalized with EPTB, patients coinfected with HIV and low CD4 counts were more likely to have CNS/meningeal and disseminated disease. Care for similar patients should include consideration of these forms of EPTB since they carry a high risk of death.
authors.affiliation: Emory University School of Medicine, Atlanta, GA 30322, USA. ileeds@emory.edu
authors.forename: Ira L
authors.initials: IL
authors.lastname: Leeds
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Magee
authors.forename: Ekaterina V
authors.initials: EV
authors.lastname: Kurbatova
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
authors.forename: Michael K
authors.initials: MK
authors.lastname: Leonard
authors.forename: Colleen S
authors.initials: CS
authors.lastname: Kraft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014376:Tuberculosis / Q000453:epidemiology / Q000821:virology*; D020306:Tuberculosis, Central Nervous System / Q000821:virology; D014481:United States / Q000453:epidemiology