Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006.

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2008-04-04

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Abstract

BACKGROUND: The proportion of extrapulmonary tuberculosis (EPTB) reported in the United States has been gradually increasing. HIV infection and foreign birth are increasingly associated with tuberculosis and understanding their effect on the clinical presentation of tuberculosis is important. METHODS: Case-control study of 6,124 persons with tuberculosis reported to the North Carolina Division of Public health from January 1, 1993 to December 31, 2006. Multivariate logistic regression was used to obtain adjusted odds ratios measuring the associations of foreign birth region and US born race/ethnicity, by HIV status, with EPTB. RESULTS: Among all patients with tuberculosis, 1,366 (22.3%) had EPTB, 563 (9.2%) were HIV co-infected, and 1,299 (21.2%) were foreign born. Among HIV negative patients, EPTB was associated with being foreign born (adjusted ORs 1.36 to 5.09, depending on region of birth) and with being US born, Black/African American (OR 1.84; 95% CI 1.42, 2.39). Among HIV infected patients, EPTB was associated with being US born, Black/African American (OR 2.60; 95% CI 1.83, 3.71) and with foreign birth in the Americas (OR 5.12; 95% CI 2.84, 9.23). CONCLUSION: Foreign born tuberculosis cases were more likely to have EPTB than US born tuberculosis cases, even in the absence of HIV infection. Increasing proportions of foreign born and HIV-attributable tuberculosis cases in the United States will likely result in a sustained burden of EPTB. Further research is needed to explore why the occurrence and type of EPTB differs by region of birth and whether host genetic and/or bacterial variation can explain these differences in EPTB.

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10.1186/1471-2458-8-107

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Kipp, Aaron M, Jason E Stout, Carol Dukes Hamilton and Annelies Van Rie (2008). Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006. BMC Public Health, 8. p. 107. 10.1186/1471-2458-8-107 Retrieved from https://hdl.handle.net/10161/11068.

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Scholars@Duke

Stout

Jason Eric Stout

Professor of Medicine

My research focuses on the epidemiology, natural history, and treatment of tuberculosis and nontuberculous mycobacterial infections. I am also interested in the impact of HIV infection on mycobacterial infection and disease, and in examining health disparities as they relate to infectious diseases, particularly in immigrant populations.

Hamilton

Carol Dukes Hamilton

Professor Emeritus of Medicine

Carol Dukes Hamilton, MD, MHS is a Professor of Medicine, Emeritus, in the Infectious Diseases Division, Department of Medicine, Duke University Medical Center.  She has nearly 40 years of experience spanning clinical care, research, public health, and global leadership. She served as clinician and full-time faculty at Duke University Medical Center from 1991 until 2008, concentrating on outpatient and inpatient clinical care (HIV/AIDS, tuberculosis [TB], and routine infectious disease problems). She expanded the nascent Antibiotic Decision Support Team (ADST) and helped establish the Division’s research program in Dar es Salaam, and later Moshi, Tanzania. While at Duke, Dr. Hamilton led the North Carolina TB Control Program in Raleigh, from 2001-2008, serving as the TB Controller for the State.  After achieving Full Professor, with Tenure status at Duke, she was recruited to Family Health International (now FHI 360) to lead development of their TB research portfolio of work, and subsequently led all TB programmatic work as well, working in numerous countries in sub-Saharan Africa (primarily Zambia, Mozambique and Nigeria), and Asia (primarily China, Myanmar, Indonesia, Cambodia), while maintaining her Duke affiliation as a Consulting Professor.  She served in several leadership positions at FHI 360, including Director of Scientific Affairs in the largest unit, the Global Health, Population & Nutrition Group, where she oversaw the quality of research done globally in health and nutrition at the organization. Dr. Hamilton has over 100 peer-reviewed publications, mostly focused on HIV/AIDS, TB and the intersection between the two diseases.  Dr. Hamilton has won numerous awards including the CDC’s Charles C. Shepard Science Award (2012), the National TB Controllers Association’s Robert Koch Award (2012), the International TB Control Cooperation Award from the China Clinical Center on Tuberculosis and the National TB Society (2014), and the US CDC’s Fred Gordin TBTC award (2018).  She retired from FHI 360 in 2018, and is now Professor, Emeritus at Duke, providing mentoring and consultation at both Duke and FHI 360.


Key words: Tuberculosis; mycobacteria other than TB (MOTT); HIV/AIDS; HAART; genomics; global health; public health;


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