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. 2014 Apr 1;65(4):438-46.
doi: 10.1097/QAI.0000000000000060.

High rates of tuberculosis in patients accessing HAART in rural South Africa

Kogieleum Naidoo  1 , Quarraisha Abdool Karim, Ambika Bhushan, Kasavan Naidoo, Nonhlanhla Yende-Zuma, Patricia K McHunu, Janet Frohlich, Farina Karim, Michele Upfold, Paul Kocheleff, Salim S Abdool Karim
Affiliations

High rates of tuberculosis in patients accessing HAART in rural South Africa

Kogieleum Naidoo et al. J Acquir Immune Defic Syndr. .

Abstract

Background: The challenge of early tuberculosis (TB) infection among rural patients accessing highly active antiretroviral therapy (HAART) in a resource-limited setting with high HIV and TB burden has not been fully quantified.

Methods: This is a retrospective study nested within a prospective study of 969 patients consecutively initiated onto HAART at the CAPRISA AIDS Treatment programme in rural KwaZulu-Natal between January 2007 and December 2010. Patients were screened for clinical symptoms consistent with TB using a standardized checklist, and routine clinical investigations that included sputum microscopy and chest x-ray diagnosis.

Results: Of 969 HIV-infected patients initiated on HAART, 173 [17.9%; 95% confidence interval (CI): 15.5 to 20.4] had active TB at HAART initiation. TB incidence rates were 3-fold higher in the first 3 months (early incident TB) after HAART initiation [11.5/100 person-years (py); 95% CI: 7.1 to 17.5] compared with 4-24 months (late incident TB) post-HAART initiation (3.2/100 py; 95% CI: 2.2 to 4.5; incidence rate ratio: 3.6; 95% CI: 2.0 to 6.4; P < 0.001). Immune status of patients at HAART initiation did not impact TB incidence rates in patients with CD4 counts of <50 (5.3/100) and >200 (4.9/100 py; P = 0.81) cells per cubic millimeter. CD4 count gains achieved 12 months post-HAART initiation were significantly different in patients with early incident TB versus late incident TB; P = 0.03.

Conclusions: Rural HIV treatment programmes in TB-endemic settings experience high rates of TB irrespective of immunologic status of patients at HAART initiation, or duration on HAART.

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Conflict of interest statement

Conflicts of Interest

All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Flow chart depicting TB burden in a community based HAART programme
Definitions: Past history of TB: patient who completed TB treatment prior to HAART initiation; Recent history of TB: episode of TB within the year prior to HAART initiation; Remote history of TB: TB episode more than a year prior to HAART initiation; Prevalent TB: patient for whom treatment was ongoing during HAART initiation. Incident TB: new cases of TB diagnosed after HAART initiation which was further divided into ““early incident” TB” defined as a new TB diagnosis with 3 months of HAART initiation, and late incident TB defined as new TB diagnosis 4–24 months post HAART initiation.; PTB: pulmonary TB; EPTB: extra-pulmonary TB, including cases of both PTB and EPTB; CAT = The Centre for the AIDS Programme of Research in South Africa (CAPRISA) AIDS Treatment Programme Notes: Past history of TB information was available for 947 individuals. Cohort included all patients enrolled onto HAART between January 2007 and December 2010; with patient follow-up time from enrolment date up until June 2011, when database was closed.
Figure 2
Figure 2
Kaplan-Meier estimates of cumulative probability of developing early incident TB
See this image and copyright information in PMC

References

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