Risk of tuberculosis following HIV seroconversion in high-income countries.

Abstract

BACKGROUND:

Few data exist on tuberculosis (TB) incidence according to time from HIV seroconversion in high-income countries and whether rates following initiation of a combination of antiretroviral treatments (cARTs) differ from those soon after seroconversion.

METHODS:

Data on individuals with well estimated dates of HIV seroconversion were used to analyse post-seroconversion TB rates, ending at the earliest of 1 January 1997, death or last clinic visit. TB rates were also estimated following cART initiation, ending at the earliest of death or last clinic visit. Poisson models were used to examine the effect of current and past level of immunosuppression on TB risk after cART initiation.

RESULTS:

Of 19 815 individuals at risk during 1982-1996, TB incidence increased from 5.89/1000 person-years (PY) (95% CI 3.77 to 8.76) in the first year after seroconversion to 10.56 (4.83 to 20.04, p=0.01) at 10 years. Among 11 178 TB-free individuals initiating cART, the TB rate in the first year after cART initiation was 4.23/1000 PY (3.07 to 5.71) and dropped thereafter, remaining constant from year 2 onwards averaging at 1.64/1000 PY (1.29 to 2.05). Current CD4 count was inversely associated with TB rates, while nadir CD4 count was not associated with TB rates after adjustment for current CD4 count, HIV-RNA at cART initiation.

CONCLUSIONS:

TB risk increases with duration of HIV infection in the absence of cART. Following cART initiation, TB incidence rates were lower than levels immediately following seroconversion. Implementation of current recommendations to prevent TB in early HIV infection could be beneficial.

• Authors: Sara Lodi, Julia del Amo, Antonella d'Arminio Monforte, Sophie Abgrall, Caroline Sabin, Charles Morrison, Hansjakob Furrer, Roberto Muga, Kholoud Porter, Enrico Girardi, CASCADE collaboration in EuroCoord
• Journal: Thorax (Thorax) Vol. 68 Issue 3 Pg. 207-13 (Mar 2013) ISSN: 1468-3296 [Electronic] England
• PMID: 23117980 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Retroviral Agents
• RNA, Viral

Topics

• AIDS-Related Opportunistic Infections (epidemiology, microbiology)
• Africa South of the Sahara (epidemiology)
• Anti-Retroviral Agents (therapeutic use)
• Australia (epidemiology)
• CD4 Lymphocyte Count
• Canada (epidemiology)
• Coinfection
• Developed Countries (statistics & numerical data)
• Europe (epidemiology)
• Female
• HIV Seropositivity (complications, drug therapy, immunology)
• Humans
• Incidence
• Male
• Poisson Distribution
• RNA, Viral (blood)
• Risk Factors
• Time Factors
• Tuberculosis (epidemiology, microbiology)