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. 2011 Apr;56(4):349-55.
doi: 10.1097/QAI.0b013e3181f9fb39.

Tuberculosis in patients receiving antiretroviral treatment: incidence, risk factors, and prevention strategies

Annelies Van Rie  1 , Daniel Westreich, Ian Sanne
Affiliations

Tuberculosis in patients receiving antiretroviral treatment: incidence, risk factors, and prevention strategies

Annelies Van Rie et al. J Acquir Immune Defic Syndr. 2011 Apr.

Abstract

Objective: To determine tuberculosis (TB) incidence rates and risk factors among individuals receiving antiretroviral treatment (ART).

Design: Observational cohort in Johannesburg, South Africa.

Methods: Incident TB was classified as early (less than 6 months of ART) or late (greater than 6 months of ART) incident TB. CD4 cell counts, viral load, body mass index, and hemoglobin were measured 6-monthly. Hazard ratios for factors associated with early and late incident TB were assessed using Cox proportional hazards regression.

Results: During 13,416 person-years of follow-up, 501 TB cases occurred among 7536 individuals, corresponding to a 10% risk in the first 4 years of ART and an overall incidence rate of 4.2 cases/100 person-years. The highest incidence rate (21.7 per 100 person-years) was observed in the first 3 months of ART among people with CD4 count below 50 cells/mm3. Low baseline CD4 count, anemia, and low body mass index were the strongest risk factors for early incident TB. Low updated CD4 count, low updated body mass index, anemia, and high viral load on ART were strong risk factors for late incident TB.

Conclusions: Severity of HIV disease and unfavorable response to ART are associated with early and late incident TB, respectively. Early ART initiation and intensified TB screening at ART initiation are crucial to reduce incident TB.

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Conflict of interest statement

The authors have no financial, consultant, institutional or other conflict of interest to declare.

Figures

Figure 1
Figure 1
Incidence rates of tuberculosis (TB) by time on antiretroviral treatment (ART) and baseline CD4 count category (< 50, 51–100, 101–200, > 200 cells/mm3). Numbers in table below figure represent the number of TB cases observed over the total number of people on ART who completed follow up during the respective time periods, by CD4 count category.
See this image and copyright information in PMC

References

    1. WHO. Epidemiology, strategy, financing. Geneva, Switzerland: 2009. Global Tuberculosis Control 2009.
    1. Badri M, Wilson D, Wood R. Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: a cohort study. Lancet. 2002 Jun 15;359(9323):2059–2064. - PubMed
    1. Jones JL, Hanson DL, Dworkin MS, DeCock KM. HIV-associated tuberculosis in the era of highly active antiretroviral therapy. The Adult/Adolescent Spectrum of HIV Disease Group. Int J Tuberc Lung Dis. 2000 Nov;4(11):1026–1031. - PubMed
    1. Kirk O, Gatell JM, Mocroft A, et al. Infections with Mycobacterium tuberculosis and Mycobacterium avium among HIV-infected patients after the introduction of highly active antiretroviral therapy. EuroSIDA Study Group JD. Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):865–872. - PubMed
    1. Moore D, Liechty C, Ekwaru P, et al. Prevalence, incidence and mortality associated with tuberculosis in HIV-infected patients initiating antiretroviral therapy in rural Uganda. Aids. 2007 Mar 30;21(6):713–719. - PubMed

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