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. 2023 Apr 15;92(5):359-369.
doi: 10.1097/QAI.0000000000003152. Epub 2023 Jan 3.

Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021

Kavitha Ganesan  1   2   3 , Ronald Mwesigwa  4 , Nicole Dear  1   2 , Allahna L Esber  1   2 , Domonique Reed  1   2   3 , Hannah Kibuuka  4 , Michael Iroezindu  1   5 , Emmanuel Bahemana  1   6 , John Owuoth  7   8 , Valentine Singoei  7   8 , Jonah Maswai  1   9 , Ajay P Parikh  1   2 , Trevor A Crowell  1   2 , Julie A Ake  1 , Christina S Polyak  1   2 , Neha Shah  1 , Joseph S Cavanaugh  1 ; AFRICOS Study Group; AFRICOS Study Group
Collaborators, Affiliations

Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021

Kavitha Ganesan et al. J Acquir Immune Defic Syndr. .

Abstract

Background: The prevalence and incidence of tuberculosis (TB) is high among people living with HIV (PLWH) but is often underdiagnosed in HIV programmatic settings.

Setting: President's Emergency Plan for AIDS Relief (PEPFAR)-supported research sites in Uganda, Kenya, Tanzania, and Nigeria.

Methods: All patients underwent molecular testing at entry into a longitudinal cohort of PLWH and annually thereafter. We assessed the prevalence and incidence of TB and identified clinical and demographic factors associated with prevalent and incident TB using logistic regression and Cox proportional hazard models.

Results: From 21 January, 2013, to 1 December 2021, 3171 PLWH were enrolled with a TB prevalence of 3% (n = 93). Of the cases with prevalent TB, 66% (n = 61) were bacteriologically confirmed. The adjusted odds of prevalent TB were significantly higher among those with higher educational attainment, PLWH for 1-5 years since their HIV diagnosis, those who were underweight, and those with CD4 counts <200 cells/mm 3 . The overall TB incidence rate was 600 per 100,000 person-years (95% CI: 481-748). We found that shorter time since HIV diagnosis, being underweight, taking antiretroviral therapy <6 months, and having a CD4 count <200 cells/mm 3 were significantly associated with incident TB. PLWH on dolutegravir/lamivudine/tenofovir had a 78% lower risk of incident TB compared with those on tenofovir/lamivudine/efavirenz (hazard ratio: 0.22; 95% CI: 0.08-0.63).

Conclusion: The prevalence and incidence of TB was notably high in this cohort sourced from PEPFAR clinics. Aggressive efforts to enhance HIV diagnosis and optimize treatment in programmatic settings are warranted to reduce the risk of HIV-TB co-occurrence in this cohort.

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Conflict of interest statement

This work was supported by the President's Emergency Plan for AIDS Relief through a cooperative agreement between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the US Department of Defense [W81XWH-11-2-0174 and W81XWH-18-2-0040]. The views expressed are those of the authors and should not be construed to represent the positions of the US Army or the Department of Defense. The investigators have adhered to the policies for the protection of human subjects, as prescribed in AR 70–25. Research reported in this publication was also supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number T32AI114398. The opinions expressed in this article are the author's own and do not reflect the view of the National Institutes of Health, the US Department of Health and Human Services, or the US government. The authors declare no conflicts of interest. The authors have no conflicts of interest to disclose.

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