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Association of HIV infection with extrapulmonary tuberculosis: a systematic review

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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 I 2 test for heterogeneity) were performed.

Results

Sixteen studies (15 cross-sectional and 1 case–control) conducted from 1984 to 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 I 2 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.

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Acknowledgements

We would like to thank Kay Dickerson, Tianjing Li and especially Ian Saldanha for helpful discussion and advice on the paper. We would also like to thank Natasha Chida and Matthew Bates, authors from the selected papers, for providing us with added information and analyses for this publication. RS was supported by a training grant from the National Institute of Health (K99HD089753). Otherwise, this work did not have any funding sources.

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    Authors and Affiliations

    1. Johns Hopkins School of Medicine, 600 N Wolfe St, Phipps 521, Baltimore, MD, 21287, USA

      Rupak Shivakoti & Kiemanh Pham

    2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

      Davina Sharma, Gabeena Mamoon & Kiemanh Pham

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    1. Rupak Shivakoti
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    2. Davina Sharma
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    Correspondence to Rupak Shivakoti.

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    Rupak Shivakoti, Davina Sharma, and Kiemanh Pham have contributed equally to this work.

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    Shivakoti, R., Sharma, D., Mamoon, G. et al. Association of HIV infection with extrapulmonary tuberculosis: a systematic review. Infection 45, 11–21 (2017). https://doi.org/10.1007/s15010-016-0960-5

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