Factors associated with extrapulmonary tuberculosis as an AIDS-defining disease in Europe

Summary Setting: Western Europe: 8 countries and the city of Amsterdam. Objective: To identify factors associated with extrapulmonary tuberculosis (EPTB) at AIDS diagnosis among adult AIDS patients. Design: The proportion of AIDS cases diagnosed between January 1988 and June 1992 with EPTB was analysed by age, gender, year of diagnosis, country and HIV transmission category. Multiple logistic regression was performed separately for patients infected through heterosexual contact who were likely to originate from Africa or the Caribbean (heterosexual subgroup 1), and for other patients. Results: The overall proportion with EPTB was 4.6% and remained stable between 1988 and 1992. It differed significantly by country (from 2.4% in the United Kingdom to 24.7% in Portugal) and by transmission category (2.7% among homo/bisexuals, 5.8% among injecting drug users, 13.6% among heterosexual subgroup 1). In multivariate analysis, the risk of EPTB was independently associated with younger age and male gender. Among patients other than from heterosexual subgroup 1, country and transmission category were also independent predictors of EPTB at AIDS diagnosis. Conclusion: The risk of presenting EPTB as an AIDS-defining disease is not homogeneous within Europe. Results suggest an increased risk of tuberculosis in specific groups of HIV-infected persons (persons originating from sub-Saharan Africa, injecting drug users) and a potential role of recent Mycobacterium tuberculosis infection among younger patients.