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Thorax. Risk of tuberculosis following HIV seroconversion in high-income countries

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  • Thorax. Risk of tuberculosis following HIV seroconversion in high-income countries

    [Source: Thorax, full text: (LINK). Abstract, edited.]
    <CITE><ABBR>Thorax</ABBR>2013;68:207-213 doi:10.1136/thoraxjnl-2012-201740 </CITE>
    <CITE></CITE>
    <CITE></CITE>Tuberculosis / Original article

    Risk of tuberculosis following HIV seroconversion in high-income countries


    Sara Lodi 1,2, Julia del Amo 2, Antonella d'Arminio Monforte 3, Sophie Abgrall 4, Caroline Sabin 5, Charles Morrison 6, Hansjakob Furrer 7, Roberto Muga 8, Kholoud Porter 1, Enrico Girardi 9, on behalf of the CASCADE collaboration in EuroCoord*

    Author Affiliations: <SUP>1</SUP>Clinical Trials Unit, Medical Research Council, London, UK <SUP>2</SUP>Instituto de Salud Carlos III, Madrid, Spain <SUP>3</SUP>San Paolo Hospital, University of Milan, Milan, Italy <SUP>4</SUP>INSERM U 943, Paris, France <SUP>5</SUP>University College London, London, UK <SUP>6</SUP>FHI 360, Durham, North Carolina, USA <SUP>7</SUP>Clinic for Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland <SUP>8</SUP>Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain <SUP>9</SUP>National Institute of Infectious Diseases, Spallanzani, Roma, Italy

    <SUP>*</SUP>See online appendix.

    Correspondence to Dr Sara Lodi, Instituto de Salud Carlos III, Avenida Monforte de Lemos 5, 28029 Madrid, Spain; slodi@isciii.es

    Received 9 February 2012 - Revised 16 August 2012 - Accepted 13 September 2012 - Published Online First 31 October 2012



    Abstract

    Background

    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.


    Methods

    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.


    Results

    Of 19 815 individuals at risk during 19821996, 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.


    Conclusions

    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.
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