{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:08:18Z","timestamp":1791389298907,"version":"4.3.3"},"reference-count":36,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T00:00:00Z","timestamp":1568160000000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["K08 AI104352"],"award-info":[{"award-number":["K08 AI104352"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["U01AI069907"],"award-info":[{"award-number":["U01AI069907"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["U01AI069911"],"award-info":[{"award-number":["U01AI069911"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["U01AI069918"],"award-info":[{"award-number":["U01AI069918"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["U01AI069919"],"award-info":[{"award-number":["U01AI069919"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["U01AI069923"],"award-info":[{"award-number":["U01AI069923"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["U01AI069924"],"award-info":[{"award-number":["U01AI069924"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["U01AI096299"],"award-info":[{"award-number":["U01AI096299"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,9]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n \n Extrapulmonary tuberculosis (\n EPTB<\/jats:styled-content>\n ) is difficult to confirm bacteriologically and requires specific diagnostic capacities. Diagnosis can be especially challenging in under\u2010resourced settings. We studied diagnostic modalities and clinical outcomes of\n EPTB<\/jats:styled-content>\n compared to pulmonary tuberculosis (\n PTB<\/jats:styled-content>\n ) among\n HIV<\/jats:styled-content>\n \u2010positive adults in antiretroviral therapy (\n ART<\/jats:styled-content>\n ) programmes in low\u2010 and middle\u2010income countries (\n LMIC<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We collected data from\n HIV<\/jats:styled-content>\n \u2010positive\n TB<\/jats:styled-content>\n patients (\u226516\u00a0years) in 22\n ART<\/jats:styled-content>\n programmes participating in the International Epidemiology Databases to Evaluate\n AIDS<\/jats:styled-content>\n (Ie\n DEA<\/jats:styled-content>\n ) consortium in sub\u2010Saharan Africa, Asia\u2010Pacific, and Caribbean, Central and South America regions between 2012 and 2014. We categorized\n TB<\/jats:styled-content>\n as\n PTB<\/jats:styled-content>\n or\n EPTB<\/jats:styled-content>\n (\n EPTB<\/jats:styled-content>\n included mixed\n PTB<\/jats:styled-content>\n \/\n EPTB<\/jats:styled-content>\n ). We used multivariable logistic regression to assess associations with clinical outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results and Discussion<\/jats:title>\n \n We analysed 2695\n HIV<\/jats:styled-content>\n \u2010positive\n TB<\/jats:styled-content>\n patients. Median age was 36\u00a0years (interquartile range (\n IQR<\/jats:styled-content>\n ) 30 to 43), 1102 were female (41%), and the median\n CD<\/jats:styled-content>\n 4 count at\n TB<\/jats:styled-content>\n treatment start was 114 cells\/\u03bcL (\n IQR<\/jats:styled-content>\n 40 to 248). Overall, 1930 had\n PTB<\/jats:styled-content>\n (72%), and 765\n EPTB<\/jats:styled-content>\n (28%). Among\n EPTB<\/jats:styled-content>\n patients, the most frequently involved sites were the lymph nodes (24%), pleura (15%), abdomen (11%) and meninges (6%). The majority of\n PTB<\/jats:styled-content>\n (1123 of 1930, 58%) and\n EPTB<\/jats:styled-content>\n (582 of 765, 76%) patients were diagnosed based on clinical criteria. Bacteriological confirmation (using positive smear microscopy, culture, Xpert\n MTB<\/jats:styled-content>\n \/\n RIF<\/jats:styled-content>\n , or other nucleic acid amplification tests result) was obtained in 897 of 1557\n PTB<\/jats:styled-content>\n (52%) and 183 of 438\n EPTB<\/jats:styled-content>\n (42%) patients.\n EPTB<\/jats:styled-content>\n was not associated with higher mortality compared to\n PTB<\/jats:styled-content>\n (adjusted odd ratio (\n aOR<\/jats:styled-content>\n ) 1.0, 95%\n CI<\/jats:styled-content>\n 0.8 to 1.3), but\n TB<\/jats:styled-content>\n meningitis was (\n aOR<\/jats:styled-content>\n 1.9, 95%\n CI<\/jats:styled-content>\n 1.0 to 3.1). Bacteriological confirmation was associated with reduced mortality among\n PTB<\/jats:styled-content>\n patients (\n aOR<\/jats:styled-content>\n 0.7, 95% CI 0.6 to 0.8) and\n EPTB<\/jats:styled-content>\n patients (\n aOR<\/jats:styled-content>\n 0.3 95% CI 0.1 to 0.8) compared to\n TB<\/jats:styled-content>\n patients with a negative test result.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Diagnosis of\n EPTB<\/jats:styled-content>\n and\n PTB<\/jats:styled-content>\n at\n ART<\/jats:styled-content>\n programmes in\n LMIC<\/jats:styled-content>\n was mainly based on clinical criteria. Greater availability and usage of\n TB<\/jats:styled-content>\n diagnostic tests would improve the diagnosis and clinical outcomes of both\n EPTB<\/jats:styled-content>\n and\n PTB<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jia2.25392","type":"journal-article","created":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T03:04:37Z","timestamp":1568171077000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low\u2010 and middle\u2010income countries: a multicohort study"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7915-3194","authenticated-orcid":false,"given":"Kathrin","family":"Z\u00fcrcher","sequence":"first","affiliation":[{"name":"Institute of Social and Preventive Medicine (ISPM) University of Bern Bern 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