TY - JOUR
T1 - Risk of tuberculosis following HIV seroconversion in high-income countries
AU - Lodi, Sara
AU - del Amo, Julia
AU - D'Arminio Monforte, Antonella
AU - Abgrall, Sophie
AU - Sabin, Caroline
AU - Morrison, Charles
AU - Furrer, Hansjakob
AU - Muga, Roberto
AU - Porter, Kholoud
AU - Girardi, Enrico
AU - AUTHOR GROUP
AU - Meyer, Laurence
AU - Bucher, Heiner C.
AU - Chêne, Geneviève
AU - Hamouda, Osamah
AU - Pillay, Deenan
AU - Prins, Maria
AU - Rosinska, Magda
AU - Olson, Ashley
AU - Coughlin, Kate
AU - Walker, Sarah
AU - Babiker, Abdel
AU - de Luca, Andrea
AU - Fisher, Martin
AU - Zangerle, Robert
AU - Kelleher, Tony
AU - Cooper, David
AU - Grey, Pat
AU - Finlayson, Robert
AU - Bloch, Mark
AU - Ramacciotti, Tim
AU - Gelgor, Linda
AU - Smith, Don
AU - Gill, John
AU - Lutsar, Irja
AU - Dabis, Francois
AU - Thiebaut, Rodolphe
AU - Masquelier, Bernard
AU - Costagliola, Dominique
AU - Guiguet, Marguerite
AU - Boufassa, Faroudy
AU - Kücherer, Claudia
AU - Bartmeyer, Barbara
AU - Touloumi, Giota
AU - Pantazis, Nikos
AU - Katsarou, Olga
AU - Rezza, Giovanni
AU - Geskus, Ronald
AU - van der Helm, Jannie
AU - Schuitemaker, Hanneke
AU - Sannes, Mette
PY - 2013
Y1 - 2013
N2 - Few data exist on tuberculosis (TB) incidence according to time from HIV seroconversion in high-income countries and whether rates following initiation of a combination of antiretroviral treatments (cARTs) differ from those soon after seroconversion. Data on individuals with well estimated dates of HIV seroconversion were used to analyse post-seroconversion TB rates, ending at the earliest of 1 January 1997, death or last clinic visit. TB rates were also estimated following cART initiation, ending at the earliest of death or last clinic visit. Poisson models were used to examine the effect of current and past level of immunosuppression on TB risk after cART initiation. Of 19 815 individuals at risk during 1982-1996, TB incidence increased from 5.89/1000 person-years (PY) (95% CI 3.77 to 8.76) in the first year after seroconversion to 10.56 (4.83 to 20.04, p=0.01) at 10 years. Among 11 178 TB-free individuals initiating cART, the TB rate in the first year after cART initiation was 4.23/1000 PY (3.07 to 5.71) and dropped thereafter, remaining constant from year 2 onwards averaging at 1.64/1000 PY (1.29 to 2.05). Current CD4 count was inversely associated with TB rates, while nadir CD4 count was not associated with TB rates after adjustment for current CD4 count, HIV-RNA at cART initiation. TB risk increases with duration of HIV infection in the absence of cART. Following cART initiation, TB incidence rates were lower than levels immediately following seroconversion. Implementation of current recommendations to prevent TB in early HIV infection could be beneficial
AB - Few data exist on tuberculosis (TB) incidence according to time from HIV seroconversion in high-income countries and whether rates following initiation of a combination of antiretroviral treatments (cARTs) differ from those soon after seroconversion. Data on individuals with well estimated dates of HIV seroconversion were used to analyse post-seroconversion TB rates, ending at the earliest of 1 January 1997, death or last clinic visit. TB rates were also estimated following cART initiation, ending at the earliest of death or last clinic visit. Poisson models were used to examine the effect of current and past level of immunosuppression on TB risk after cART initiation. Of 19 815 individuals at risk during 1982-1996, TB incidence increased from 5.89/1000 person-years (PY) (95% CI 3.77 to 8.76) in the first year after seroconversion to 10.56 (4.83 to 20.04, p=0.01) at 10 years. Among 11 178 TB-free individuals initiating cART, the TB rate in the first year after cART initiation was 4.23/1000 PY (3.07 to 5.71) and dropped thereafter, remaining constant from year 2 onwards averaging at 1.64/1000 PY (1.29 to 2.05). Current CD4 count was inversely associated with TB rates, while nadir CD4 count was not associated with TB rates after adjustment for current CD4 count, HIV-RNA at cART initiation. TB risk increases with duration of HIV infection in the absence of cART. Following cART initiation, TB incidence rates were lower than levels immediately following seroconversion. Implementation of current recommendations to prevent TB in early HIV infection could be beneficial
U2 - https://doi.org/10.1136/thoraxjnl-2012-201740
DO - https://doi.org/10.1136/thoraxjnl-2012-201740
M3 - Article
C2 - 23117980
SN - 0040-6376
VL - 68
SP - 207
EP - 213
JO - Thorax
JF - Thorax
IS - 3
ER -