SOCIODEMOGRAPHIC PREDICTORS AND TEMPORAL TRENDS OF EXTRAPULMONARY TUBERCULOSIS AS AN AIDS-DEFINING DISEASE IN SPAIN

Objective: To identify the factors associated with the presentation of extrapulmonary tuberculosis (EPTB) in AIDS diagnosis and to analyse i ts temporal trend. Design: Analysis of AIDS surveillance data. Methods : The study was based on AIDS cases diagnosed in Spain between 1988 an d 1993, and reported up to September 1994. The proportion of patients presenting with EPTB at AIDS diagnosis was analysed by sociodemographi c characteristics and year of diagnosis. Results: Of the 22 445 AIDS c ases diagnosed in Spain from 1988 to 1993, 6526 patients (29.1%; 95% c onfidence interval, 28.5-29.7) presented with EPTB at diagnosis, makin g it the most frequent AIDS-defining disease. The highest proportions of EPTB reported at AIDS diagnosis were observed for injecting drug us ers (IDU; 35.4%) and the heterosexual transmission category (23.5%). T he proportion of EPTB was lower in women [relative risk (RR), 0.85; P< 0.001], and higher in 15-29-year-olds (34.2%) and patients with a pris on record (44.3 versus 25.4%; RR, 1.75; P<0.001). AIDS patients reside nt in provinces with high respiratory TB mortality rates among the gen eral population exhibited a higher proportion of EPTB (RR, 1.45; P<0.0 01). The effect of any one variable was maintained by controlling for all others. The proportion of patients with EPTB at AIDS diagnosis rev ealed a downward trend from 1988 to 1993 (P=0.007), which was observed in IDU and heterosexuals but not in homosexual/bisexual men (P=0.421) . Conclusions: Factors such as injecting drug use, prison record or re sidence in high TB-endemic areas are associated with a greater frequen cy of EPTB at AIDS diagnosis. These factors must be considered for spe cific prophylaxis to be efficiently applied.