Association of HIV infection with extrapulmonary tuberculosis: a systematic review

Abstract

Purpose HIV/AIDS is a known risk factor for the development of pulmonary tuberculosis (PTB). However, the association is less clear between HIV and extrapulmonary tuberculosis (EPTB). We conducted a systematic review to determine the association between HIV and EPTB. Methods We searched the electronic databases Medline, Embase and relevant conference literature using defined search terms for EPTB and HIV. Only publications in English and only studies reporting adjusted estimates were included while our search criteria did not include restriction by age or geographic location of study participants. Qualitative and quantitative analyses (including I2 test for heterogeneity) were performed. Results 16 studies (15 cross-sectional and 1 case-control) conducted from 1984-2016 were included in the final analyses after screening 5163 articles and conference abstracts. Our qualitative analysis showed heterogeneity in study design and study population characteristics along with a medium/high risk of bias in the majority of studies. While most of the individual studies showed increased odds of EPTB compared with PTB among HIV-infected individuals, we did not provide an overall pooled estimate, as the I2 value was high at 93% for the cross-sectional studies. Conclusions While an association between HIV and EPTB is observed in most individual studies, the high heterogeneity and risk of bias in these studies highlight the need for further well-designed prospective cohort studies to assess the true risk of EPTB in the HIV infected patient population.

Child and adult spinal tuberculosis at tertiary hospitals in the Western Cape, South Africa: 4-year burden and trend

“…Fifty-seven per cent of adults in the current study were female, a finding in keeping with previous spinal TB studies from South Africa [7, 8, 25, 26] but in contrast to other large studies in which 51–61% of spinal TB cases were male [4, 11, 12, 24]. One possible explanation for this difference is HIV infection and its oft-cited association with extra-pulmonary TB disease [27, 28]. For example, whereas HIV co-infection was ⩽4% [4, 24] or not reported [11, 12] in the afore-mentioned studies from other parts of the world, 56% of adult females and 36% of adult males with known HIV status in the current study were HIV-positive, indicating a significantly higher HIV-positive prevalence among adult females in this study.…”

“…In the current study, 50% of all spinal TB cases were between 23 and 47 years old with a median age of 38 years among adult cases (Table 1). While previous studies from the USA [4] and Eastern Mediterranean [11] reported a somewhat older median age of approximately 50 years among spinal TB cases, the current age distribution is similar to findings from Kenya [24] and China (27) 110 (28) Data are presented as n (%) for non-missing data, unless otherwise indicated, with % values rounded to the nearest whole number. a MRI, magnetic resonance imaging (n = 378); CT, computed tomography (n = 4).…”

Clinical and pathologic analyses of tuberculosis in the oral cavity: report of 11 cases

“…The lymph nodes are the most common location of TB after the lungs. 9,10 TB lesions in the oral cavity are rare, 11 and most originate from pulmonary TB, so they can be considered secondary TB. Primary TB in the oral cavity without pulmonary involvement is rare, but it is more commonly found in children and adolescents.…”

Persistent Cutaneous Metastatic Tubercular Abscesses Revealing Multifocal Tuberculosis in an Immunocompetent Patient

“…Tuberculosis, a curable infectious disease once thought to be a death sentence, still remains as one of the 10 leading causes of death worldwide [1,2]. Lungs were classically the primary target for tuberculosis, but these recent years, extrapulmonary tuberculosis has become more frequent especially with the increase in Human Immunodeficiency Virus (HIV) infection rates [3]. This resulted in a large diversity in clinical presentations.…”