Incidence and risk factors for tuberculosis in HIV-positive subjects by HAART status
Abstract:OBJECTIVE: To estimate incidence rates and risk factors for tuberculosis (TB) in human immunodeficiency virus seroprevalent subjects.
METHODS: Multicentre, hospital-based cohort study of patients presenting to 10 Spanish hospitals from 1 January 1997 to 31 December 2003. Poisson regression was used and highly active antiretroviral treatment (HAART) was modelled as a time-dependent covariate.
RESULTS: A total of 4268 patients were followed for a median of 3.8 years; 221 TB cases were diagnosed over 16 464 person-years (py). TB rates were higher in HAART-naïve subjects (1.56 per 100 py, 95%CI 1.36–1.79) than those on HAART (0.5/100 py, 95%CI 0.31–0.80). Among HAART-naïves, TB risk factors were: being male, being an injecting drug user (IDU) (RR 2.01, 95%CI 1.28–3.16), having low CD4 counts (P < 0.001) and high viral loads (P < 0.001). HAART was protective (RR 0.26, 95%CI 0.16–0.40) and reductions in TB rates were observed in the last calendar period (RR 0.74, 95%CI 0.55–1.00). For patients on HAART, no differences were observed by category of transmission. Low CD4 counts at entry were associated with higher TB rates (P < 0.001).
CONCLUSIONS: HAART was associated with lower TB rates, and TB risk factors differed according to whether or not patients had received HAART. To further reduce TB rates, additional strategies are needed, such as timely access and adherence to HAART, especially in IDUs.
Document Type: Regular Paper
Affiliations: 1: Hospital Ramon y Cajal, Universidad de Alcala, Madrid, Spain 2: Universidad Miguel Hernandez, Alicante, Spain; and Instituto de Salud Carlos III, Madrid, Spain 3: Hospital Donostia, San Sebastian, Spain 4: Hospital Universitario Virgen del Rocio, Sevilla, Spain 5: Hospital Clinico Universitario San Cecilio, Granada, Spain 6: Hospital Universitario de Canarias, Tenerife, Spain 7: Hospital La Fe, Valencia, Spain 8: Hospital Universitario de Elche, Universidad Miguel Hernandez, Elche, Alicante, Spain 9: Hospital de San Pedro, Logroño, Spain 10: Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain 11: Centro Salud Publica, Denia, Alicante, Spain 12: Universidad Miguel Hernandez, Alicante, Spain; and Universidad Rey Juan Carlos I, Madrid, Spain
Publication date: December 1, 2008
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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