Distinct Clinical Features of Extrapulmonary and Disseminated Tuberculosis in HIV- and Non-HIV-Associated Immunosuppression: A Retrospective Cohort Study.

BACKGROUND

There is scarce information regarding the clinical differences between extrapulmonary and disseminated tuberculosis (TB) in patients with different types of immunosuppression. We aimed to compare the clinical characteristics and outcomes of extrapulmonary and disseminated TB in patients with non-human immunodeficiency virus (HIV)-associated and HIV-associated immunocompromise.

METHODS

In this retrospective cohort study, we included immunocompromised adults with extrapulmonary or disseminated TB in a referral center in Mexico City from January 2000 to December 2023. We compared clinical characteristics, treatments, and death. Multivariate logistic regression analysis for death-related characteristics and Kaplan-Meier survival estimates were performed.

RESULTS

We included 180 patients: 81 with non-HIV-associated and 99 with HIV-associated immunosuppression (CD4+ <200 cells/µL). Most were male (62%), with a median age of 34 (interquartile range, 29-47) years. Among all patients, 55% had HIV infection and 33% had autoimmune disease. Disseminated disease was more frequent in the HIV group (80% vs 63%, P = .02). Infections by Mycobacterium bovis were more prevalent in the non-HIV group (54% vs 36%, P = .02). Death occurred in 23% of cases. Factors related to death (odds ratio [95% confidence interval]) were age ( 1.05 [1.01-1.10]), unemployment (31.62 [1.65-605.18]), tobacco use (4.21 [1.03-17.21]), disseminated disease (6.13 [1.24-30.35]), and central nervous system (CNS) involvement (10.10 [1.91-53.53]) in the non-HIV group, and malignancy (33.82 [2.37-483.33]) and intensive care unit admission (7.26 [1.93-27.29]) in the HIV group.

CONCLUSIONS

Disseminated TB was more frequent in the HIV group. Factors associated with mortality differed, highlighting CNS involvement in the non-HIV group and malignancy in the HIV group.