High incidence of tuberculosis in the first year of antiretroviral therapy in the Botswana National antiretroviral therapy programme between 2011 and 2015

doi:10.1097/QAD.0000000000002363

. 2019 Dec 1;33(15):2415-2422.

doi: 10.1097/QAD.0000000000002363.

High incidence of tuberculosis in the first year of antiretroviral therapy in the Botswana National antiretroviral therapy programme between 2011 and 2015

Lucy Mupfumi¹, Sikhulile Moyo, Sanghyuk S Shin, Qiao Wang, Nicola Zetola, Kesaobaka Molebatsi, Judith Nnawa, Botshelo T Kgwaadira, Lesedi Bewlay, Tony Chebani, Thato Iketleng, Tuelo Mogashoa, Joseph Makhema, Rosemary M Musonda, Max Essex, Ishmael Kasvosve, Simani Gaseitsiwe

Affiliations

Affiliation

¹ aDepartment of Medical Laboratory Sciences, School of Allied Health Professions, University of Botswana bBotswana Harvard AIDS Institute Partnership, Gaborone, Botswana cDepartment of Immunology & Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts dSue & Bill Gross School of Nursing, University of California Irvine, California eInfectious Diseases Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA fBotswana - University of Pennsylvania Partnership gDepartment of Statistics, University of Botswana hHealth Policy Development Monitoring & Evaluation, Ministry of Health & Wellness iNational TB Program, Ministry of Health & Wellness, Gaborone, Botswana jCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA kTau Technology, Gaborone, Botswana lCollege of Health Sciences, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.

PMID: 31764106
PMCID: PMC7903483
DOI: 10.1097/QAD.0000000000002363

High incidence of tuberculosis in the first year of antiretroviral therapy in the Botswana National antiretroviral therapy programme between 2011 and 2015

Lucy Mupfumi et al. AIDS. 2019.

. 2019 Dec 1;33(15):2415-2422.

doi: 10.1097/QAD.0000000000002363.

Authors

Affiliation

¹ aDepartment of Medical Laboratory Sciences, School of Allied Health Professions, University of Botswana bBotswana Harvard AIDS Institute Partnership, Gaborone, Botswana cDepartment of Immunology & Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts dSue & Bill Gross School of Nursing, University of California Irvine, California eInfectious Diseases Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA fBotswana - University of Pennsylvania Partnership gDepartment of Statistics, University of Botswana hHealth Policy Development Monitoring & Evaluation, Ministry of Health & Wellness iNational TB Program, Ministry of Health & Wellness, Gaborone, Botswana jCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA kTau Technology, Gaborone, Botswana lCollege of Health Sciences, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.

PMID: 31764106
PMCID: PMC7903483
DOI: 10.1097/QAD.0000000000002363

Abstract

Objective: Tuberculosis (TB) remains one of the leading causes of mortality and morbidity among people living with HIV. We sought to estimate the incidence of TB in a national database of HIV-infected patients receiving antiretroviral therapy (ART) in Botswana.

Design: A retrospective analysis of HIV-infected adult patients (≥18years) who initiated ART between 2011 and 2015 in the Botswana ART program.

Methods: Multivariable analysis using Cox regression included sex, age, viral load and CD4 T-cell counts.

Results: Of 45 729 patients, with a median follow-up of 1.7 years Q1 : Q3, 0.5, 3.1), 1791 patients developed TB over a median of 1.5 years (Q1 : Q3, 0.3, 3.1) of follow-up (incidence rate 1.9 per 100 person-years; 95% CI 1.8-2.0). At baseline, the median CD4 T-cell count was 272 cells/μl (Q1, Q3 146, 403). The risk of TB was greatest within the first year of ART (incidence rate 2.9 per 100 person-years; 95% CI 2.7-3.1) and in patients with CD4 T-cell counts below 50 cells/μl (incidence rate 8.3/100 person-years; 95% CI 7.1-9.7). Patients with viral loads above 10 000 copies/ml at 3 months post-ART initiation had two times higher risk of TB, hazard ratio 2.5 (95% CI 1.8-2.3).

Conclusion: We report a high incidence of TB within the first year of ART and in patients with advanced immunodeficiency. Improved screening strategies and virologic monitoring during this early period on ART, coupled with TB preventive treatment, will reduce the burden of TB.

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Conflict of interest statement

Conflict of Interest

The authors declare no conflict of interest.

Figures

**Figure2a.**
Time to incidentTB by CD4 category.

**Figure 2b.**
Time to incident TB by viral load.

**Figure 3.**
Trends in TB incidence rate with time on ART.

See this image and copyright information in PMC

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References

1. WHO. Global TB report. https://www.who.int/tb/publications/global_report/en/ Acessed 26 September 2018.
1. Westreich D, Fox MP, Van Rie A, Maskew M. Prevalent tuberculosis and mortality among HAART initiators. AIDS 2012; 26(6):770–773. - PMC - PubMed
1. Worodria W, Massinga-Loembe M, Mazakpwe D, Luzinda K, Menten J, Van Leth F, et al. Incidence and predictors of mortality and the effect of tuberculosis immune reconstitution inflammatory syndrome in a cohort of TB/HIV patients commencing antiretroviral therapy. J Acquir Immune Defic Syndr 2011; 58(1):32–37. - PubMed
1. Kufa T, Chihota V, Mngomezulu V, Charalambous S, Verver S, Churchyard G, et al. The incidence of tuberculosis among HIV-positive individuals with high CD4 counts: implications for policy. BMC infectious diseases 2016; 16:266. - PMC - PubMed
1. Bock P, Jennings K, Vermaak R, Cox H, Meintjes G, Fatti G, et al. Incidence of Tuberculosis Among HIV-Positive Individuals Initiating Antiretroviral Treatment at Higher CD4 Counts in the HPTN 071 (PopART) Trial in South Africa. J Acquir Immune Defic Syndr 2018; 77(1):93–101. - PMC - PubMed

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[1] WHO. Global TB report. https://www.who.int/tb/publications/global_report/en/ Acessed 26 September 2018.

[2] WHO. Global TB report. https://www.who.int/tb/publications/global_report/en/ Acessed 26 September 2018.

[3] Westreich D, Fox MP, Van Rie A, Maskew M. Prevalent tuberculosis and mortality among HAART initiators. AIDS 2012; 26(6):770–773. - PMC - PubMed

[4] Westreich D, Fox MP, Van Rie A, Maskew M. Prevalent tuberculosis and mortality among HAART initiators. AIDS 2012; 26(6):770–773. - PMC - PubMed

[5] Worodria W, Massinga-Loembe M, Mazakpwe D, Luzinda K, Menten J, Van Leth F, et al. Incidence and predictors of mortality and the effect of tuberculosis immune reconstitution inflammatory syndrome in a cohort of TB/HIV patients commencing antiretroviral therapy. J Acquir Immune Defic Syndr 2011; 58(1):32–37. - PubMed

[6] Worodria W, Massinga-Loembe M, Mazakpwe D, Luzinda K, Menten J, Van Leth F, et al. Incidence and predictors of mortality and the effect of tuberculosis immune reconstitution inflammatory syndrome in a cohort of TB/HIV patients commencing antiretroviral therapy. J Acquir Immune Defic Syndr 2011; 58(1):32–37. - PubMed

[7] Kufa T, Chihota V, Mngomezulu V, Charalambous S, Verver S, Churchyard G, et al. The incidence of tuberculosis among HIV-positive individuals with high CD4 counts: implications for policy. BMC infectious diseases 2016; 16:266. - PMC - PubMed

[8] Kufa T, Chihota V, Mngomezulu V, Charalambous S, Verver S, Churchyard G, et al. The incidence of tuberculosis among HIV-positive individuals with high CD4 counts: implications for policy. BMC infectious diseases 2016; 16:266. - PMC - PubMed

[9] Bock P, Jennings K, Vermaak R, Cox H, Meintjes G, Fatti G, et al. Incidence of Tuberculosis Among HIV-Positive Individuals Initiating Antiretroviral Treatment at Higher CD4 Counts in the HPTN 071 (PopART) Trial in South Africa. J Acquir Immune Defic Syndr 2018; 77(1):93–101. - PMC - PubMed

[10] Bock P, Jennings K, Vermaak R, Cox H, Meintjes G, Fatti G, et al. Incidence of Tuberculosis Among HIV-Positive Individuals Initiating Antiretroviral Treatment at Higher CD4 Counts in the HPTN 071 (PopART) Trial in South Africa. J Acquir Immune Defic Syndr 2018; 77(1):93–101. - PMC - PubMed

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High incidence of tuberculosis in the first year of antiretroviral therapy in the Botswana National antiretroviral therapy programme between 2011 and 2015

Affiliation

High incidence of tuberculosis in the first year of antiretroviral therapy in the Botswana National antiretroviral therapy programme between 2011 and 2015

Authors

Affiliation

Abstract

Conflict of interest statement

Figures

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