Risk of tuberculosis following HIV seroconversion in high-income countries
- Sara Lodi1,2,
- Julia del Amo2,
- Antonella d'Arminio Monforte3,
- Sophie Abgrall4,
- Caroline Sabin5,
- Charles Morrison6,
- Hansjakob Furrer7,
- Roberto Muga8,
- Kholoud Porter1,
- Enrico Girardi9,
- on behalf of the CASCADE collaboration in EuroCoord*
- 1Clinical Trials Unit, Medical Research Council, London, UK
- 2Instituto de Salud Carlos III, Madrid, Spain
- 3San Paolo Hospital, University of Milan, Milan, Italy
- 4INSERM U 943, Paris, France
- 5University College London, London, UK
- 6FHI 360, Durham, North Carolina, USA
- 7Clinic for Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
- 8Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain
- 9National Institute of Infectious Diseases, Spallanzani, Roma, Italy
- *See online appendix.
- Correspondence to Dr Sara Lodi, Instituto de Salud Carlos III, Avenida Monforte de Lemos 5, 28029 Madrid, Spain;
- Received 9 February 2012
- Revised 16 August 2012
- Accepted 13 September 2012
- Published Online First 31 October 2012
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 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.
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.