Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 1;87(1):720-729.
doi: 10.1097/QAI.0000000000002619.

Factors Associated With and Characteristic of HIV/Tuberculosis Co-Infection: A Retrospective Analysis of SECOND-LINE Clinical Trial Participants

Rebecca T Henry  1 , Awachana Jiamsakul  1 , Matthew Law  1 , Marcelo Losso  2 , Adeeba Kamarulzaman  3 , Praphan Phanuphak  4 , Nagalingeswaran Kumarasamy  5 , Sharne Foulkes  6 , Lerato Mohapi  7 , Chidi Nwizu  8 , Robin Wood  9 , Anthony Kelleher  1 , Mark Polizzotto  1 ; SECOND-LINE Study Group
Affiliations

Factors Associated With and Characteristic of HIV/Tuberculosis Co-Infection: A Retrospective Analysis of SECOND-LINE Clinical Trial Participants

Rebecca T Henry et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Tuberculosis (TB) is a common infection in people living with HIV. However, the risk factors for HIV/TB co-infection in second-line HIV therapy are poorly understood. We aimed to determine the incidence and risk factors for TB co-infection in SECOND-LINE, an international randomized clinical trial of second-line HIV therapy.

Methods: We did a cohort analysis of TB cases in SECOND-LINE. TB cases included any clinical or laboratory-confirmed diagnoses and/or commencement of treatment for TB after randomization. Baseline factors associated with TB were analyzed using Cox regression stratified by site.

Results: TB cases occurred at sites in Argentina, India, Malaysia, Nigeria, South Africa, and Thailand, in a cohort of 355 of the 541 SECOND-LINE participants. Overall, 20 cases of TB occurred, an incidence rate of 3.4 per 100 person-years (95% CI: 2.1 to 5.1). Increased TB risk was associated with a low CD4+-cell count (≤200 cells/μL), high viral load (>200 copies/mL), low platelet count (<150 ×109/L), and low total serum cholesterol (≤4.5 mmol/L) at baseline. An increased risk of death was associated with TB, adjusted for CD4, platelets, and cholesterol. A low CD4+-cell count was significantly associated with incident TB, mortality, other AIDS diagnoses, and virologic failure.

Discussion: The risk of TB remains elevated in PLHIV in the setting of second-line HIV therapy in TB endemic regions. TB was associated with a greater risk of death. Finding that low CD4+ T-cell count was significantly associated with poor outcomes in this population supports the value of CD4+ monitoring in HIV clinical management.

Trial registration: ClinicalTrials.gov NCT00931463.

PubMed Disclaimer

Conflict of interest statement

R.T.H. is supported by an Australian Government Research Training Program (RTP) Scholarship; M.N.P. is supported by fellowships from the Cancer Institute NSW and National Health and Medical Research Council; M. Law is supported by an investigator grant from the National Health and Medical Research Council. The other authors have no funding or conflicts of interest to disclose.

References

    1. Global Tuberculosis Report 2019. Geneva, Switzerland: World Health Organisation; 2019. Available at: http://www.who.int/tb/publications/global_report/en/ . Accessed November 7, 2019.
    1. Dravid A, Natarajan K, Medisetty M, et al. Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India. BMC Infect Dis. 2019;19:714.
    1. GBD Tuberculosis Collaborators. The global burden of tuberculosis: results from the Global Burden of Disease Study 2015. Lancet Infect Dis. 2018;18:261–284.
    1. Bell LC, Noursadeghi M. Pathogenesis of HIV-1 and mycobacterium tuberculosis co-infection. Nat Rev Microbiol. 2018;16:80–90.
    1. Sonnenberg P, Glynn JR, Fielding K, et al. How soon after infection with HIV does the risk of tuberculosis start to increase? A retrospective cohort study in South African gold miners. J Infect Dis. 2005;191:150–158.

Publication types

MeSH terms

Associated data