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. 2017 Sep;145(12):2500-2509.
doi: 10.1017/S095026881700156X. Epub 2017 Jul 27.

Reduction in extrapulmonary tuberculosis in context of antiretroviral therapy scale-up in rural South Africa

J C Hoogendoorn  1 , L Ranoto  1 , N Muditambi  1 , J Railton  1 , M Maswanganyi  2 , H E Struthers  1 , J A McIntyre  1 , R P H Peters  1
Affiliations

Reduction in extrapulmonary tuberculosis in context of antiretroviral therapy scale-up in rural South Africa

J C Hoogendoorn et al. Epidemiol Infect. 2017 Sep.

Abstract

Scale-up of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has reduced the incidence of pulmonary tuberculosis (PTB) in South Africa. Despite the strong association of HIV infection with extrapulmonary tuberculosis (EPTB), the effect of ART on the epidemiology of EPTB remains undocumented. We conducted a retrospective record review of patients initiated on treatment for EPTB in 2009 (ART coverage <5%) and 2013 (ART coverage 41%) at four public hospitals in rural Mopani District, South Africa. Data were obtained from TB registers and patients' clinical records. There was a 13% decrease in overall number of TB cases, which was similar for cases registered as EPTB (n = 399 in 2009 vs. 336 in 2013; P < 0·01) and for PTB (1031 vs. 896; P < 0·01). Among EPTB cases, the proportion of miliary TB and disseminated TB decreased significantly (both P < 0·01), TB meningitis and TB of bones increased significantly (P < 0·01 and P = 0·02, respectively) and TB pleural effusion and lymphadenopathy remained the same. This study shows a reduction of EPTB cases that is similar to that of PTB in the context of the ART scale-up. The changing profile of EPTB warrants attention of healthcare workers.

Keywords: Antiretroviral therapy; extrapulmonary tuberculosis; human immunodeficiency virus; pulmonary tuberculosis; rural South Africa.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Number of patients treated for extrapulmonary and pulmonary TB as per hospital TB registers in the context of ART-coverage in a rural district in 2009 and 2013. TB, tuberculosis; EPTB, extrapulmonary tuberculosis; PTB, pulmonary tuberculosis; ART, antiretroviral therapy.
Fig. 2.
Fig. 2.
Distribution of types of extrapulmonary tuberculosis recorded at four hospitals in Mopani District between 2009 and 2013. (a) Data from hospital TB register. (b) Data from clinical records. TB, tuberculosis; EPTB, extrapulmonary tuberculosis. P-value given as compared with total EPTB cases. *Based on the diagnosis in clinical records these include cases of TB abdomen (eight cases in 2009 vs. six cases in 2013), TB pericarditis (five cases vs. two cases, respectively), TB mastitis (one case vs. 0 cases, respectively) and TB artery (one case vs. 0 cases, respectively).
Fig. 3.
Fig. 3.
Flow chart of review of clinical records. EPTB, extrapulmonary tuberculosis; PTB, pulmonary tuberculosis.
See this image and copyright information in PMC

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