Incidence of Tuberculosis among HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy in Europe and North America
Background. We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HAART and identified determinants of the incidence. Methods. We analyzed the incidence of TB during the first 3 years after initiation of HAART among 17,142 treatment-naive, AIDS-free persons starting HA...
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| Veröffentlicht in: | Clinical infectious diseases 2005-12, Vol.41 (12), p.1772-1782 |
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| creator | Girardi, Enrico Sabin, Caroline A d'Arminio Monforte, Antonella Hogg, Bob Phillips, Andrew N Gill, M John Dabis, Francois Reiss, Peter Kirk, Ole Bernasconi, Enos Grabar, Sophie Justice, Amy Staszewski, Schlomo Fätkenheuer, Gerd Sterne, Jonathan A C |
| description | Background. We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HAART and identified determinants of the incidence. Methods. We analyzed the incidence of TB during the first 3 years after initiation of HAART among 17,142 treatment-naive, AIDS-free persons starting HAART who were enrolled in 12 cohorts from Europe and North America. We used univariable and multivariable Poisson regression models to identify factors associated with the incidence. Results. During the first 3 years (36,906 person-years), 173 patients developed TB (incidence, 4.69 cases per 1000 person-years). In multivariable analysis, the incidence rate was lower for men who have sex with men, compared with injection drug users (relative rate, 2.46; 95% confidence interval [CI], 1.51–4.01), heterosexuals (relative rate, 2.42; 95% CI, 1.64–3.59), those with other suspected modes of transmission (relative rate, 1.66; 95% CI, 0.91–3.06), and those with a higher CD4+ count at the time of HAART initiation (relative rate per log2 cells/µL, 0.87; 95% CI, 0.84–0.91). During 28,846 person-years of follow-up after the first 6 months of HAART, 88 patients developed TB (incidence, 3.1 cases per 1000 person-years of follow-up). In multivariable analyses, a low baseline CD4+ count (relative rate per log2 cells/µL, 0.89; 95% CI, 0.83–0.96), 6-month CD4+ count (relative rate per log2 cells/µL, 0.90; 95% CI, 0.81–0.99), and a 6-month HIV RNA level >400 copies/mL (relative rate, 2.21; 95% CI, 1.33–3.67) were significantly associated with the risk of acquiring TB after 6 months of HAART. Conclusion. The level of immunodeficiency at which HAART is initiated and the response to HAART are important determinants of the risk of TB. However, this risk remains appreciable even among those with a good response to HAART, suggesting that other interventions may be needed to control the TB epidemic in the HIV-infected population. |
| doi_str_mv | 10.1086/498315 |
| format | Article |
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We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HAART and identified determinants of the incidence. Methods. We analyzed the incidence of TB during the first 3 years after initiation of HAART among 17,142 treatment-naive, AIDS-free persons starting HAART who were enrolled in 12 cohorts from Europe and North America. We used univariable and multivariable Poisson regression models to identify factors associated with the incidence. Results. During the first 3 years (36,906 person-years), 173 patients developed TB (incidence, 4.69 cases per 1000 person-years). In multivariable analysis, the incidence rate was lower for men who have sex with men, compared with injection drug users (relative rate, 2.46; 95% confidence interval [CI], 1.51–4.01), heterosexuals (relative rate, 2.42; 95% CI, 1.64–3.59), those with other suspected modes of transmission (relative rate, 1.66; 95% CI, 0.91–3.06), and those with a higher CD4+ count at the time of HAART initiation (relative rate per log2 cells/µL, 0.87; 95% CI, 0.84–0.91). During 28,846 person-years of follow-up after the first 6 months of HAART, 88 patients developed TB (incidence, 3.1 cases per 1000 person-years of follow-up). In multivariable analyses, a low baseline CD4+ count (relative rate per log2 cells/µL, 0.89; 95% CI, 0.83–0.96), 6-month CD4+ count (relative rate per log2 cells/µL, 0.90; 95% CI, 0.81–0.99), and a 6-month HIV RNA level >400 copies/mL (relative rate, 2.21; 95% CI, 1.33–3.67) were significantly associated with the risk of acquiring TB after 6 months of HAART. Conclusion. The level of immunodeficiency at which HAART is initiated and the response to HAART are important determinants of the risk of TB. However, this risk remains appreciable even among those with a good response to HAART, suggesting that other interventions may be needed to control the TB epidemic in the HIV-infected population.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/498315</identifier><identifier>PMID: 16288403</identifier><language>eng</language><publisher>United States: The University of Chicago Press</publisher><subject>Adult ; AIDS ; Antiretroviral drugs ; Antiretroviral Therapy, Highly Active ; Antiretrovirals ; Drug therapy ; Europe - epidemiology ; Female ; Highly active antiretroviral therapy ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV/AIDS ; Hospitals ; Human immunodeficiency virus ; Humans ; Incidence ; Infections ; Latent tuberculosis ; Male ; Mycobacterium tuberculosis ; North America - epidemiology ; RNA ; Studies ; Tuberculosis ; Tuberculosis - complications ; Tuberculosis - epidemiology ; Virology</subject><ispartof>Clinical infectious diseases, 2005-12, Vol.41 (12), p.1772-1782</ispartof><rights>Copyright 2005 The Infectious Diseases Society of America</rights><rights>2005 by the Infectious Diseases Society of America 2005</rights><rights>Copyright University of Chicago, acting through its Press Dec 15, 2005</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-2870fe7ce6fd476b44bda63c4e5b09e7e2b27cb90dd34e830bb907e81ba647023</citedby><cites>FETCH-LOGICAL-c518t-2870fe7ce6fd476b44bda63c4e5b09e7e2b27cb90dd34e830bb907e81ba647023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/4463668$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/4463668$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,777,781,800,27905,27906,57998,58231</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16288403$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Girardi, Enrico</creatorcontrib><creatorcontrib>Sabin, Caroline A</creatorcontrib><creatorcontrib>d'Arminio Monforte, Antonella</creatorcontrib><creatorcontrib>Hogg, Bob</creatorcontrib><creatorcontrib>Phillips, Andrew N</creatorcontrib><creatorcontrib>Gill, M John</creatorcontrib><creatorcontrib>Dabis, Francois</creatorcontrib><creatorcontrib>Reiss, Peter</creatorcontrib><creatorcontrib>Kirk, Ole</creatorcontrib><creatorcontrib>Bernasconi, Enos</creatorcontrib><creatorcontrib>Grabar, Sophie</creatorcontrib><creatorcontrib>Justice, Amy</creatorcontrib><creatorcontrib>Staszewski, Schlomo</creatorcontrib><creatorcontrib>Fätkenheuer, Gerd</creatorcontrib><creatorcontrib>Sterne, Jonathan A C</creatorcontrib><creatorcontrib>Antiretroviral Therapy Cohort Collaboration</creatorcontrib><creatorcontrib>The Antiretroviral Therapy Cohort Collaboration</creatorcontrib><title>Incidence of Tuberculosis among HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy in Europe and North America</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Background. We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HAART and identified determinants of the incidence. Methods. We analyzed the incidence of TB during the first 3 years after initiation of HAART among 17,142 treatment-naive, AIDS-free persons starting HAART who were enrolled in 12 cohorts from Europe and North America. We used univariable and multivariable Poisson regression models to identify factors associated with the incidence. Results. During the first 3 years (36,906 person-years), 173 patients developed TB (incidence, 4.69 cases per 1000 person-years). In multivariable analysis, the incidence rate was lower for men who have sex with men, compared with injection drug users (relative rate, 2.46; 95% confidence interval [CI], 1.51–4.01), heterosexuals (relative rate, 2.42; 95% CI, 1.64–3.59), those with other suspected modes of transmission (relative rate, 1.66; 95% CI, 0.91–3.06), and those with a higher CD4+ count at the time of HAART initiation (relative rate per log2 cells/µL, 0.87; 95% CI, 0.84–0.91). During 28,846 person-years of follow-up after the first 6 months of HAART, 88 patients developed TB (incidence, 3.1 cases per 1000 person-years of follow-up). In multivariable analyses, a low baseline CD4+ count (relative rate per log2 cells/µL, 0.89; 95% CI, 0.83–0.96), 6-month CD4+ count (relative rate per log2 cells/µL, 0.90; 95% CI, 0.81–0.99), and a 6-month HIV RNA level >400 copies/mL (relative rate, 2.21; 95% CI, 1.33–3.67) were significantly associated with the risk of acquiring TB after 6 months of HAART. Conclusion. The level of immunodeficiency at which HAART is initiated and the response to HAART are important determinants of the risk of TB. However, this risk remains appreciable even among those with a good response to HAART, suggesting that other interventions may be needed to control the TB epidemic in the HIV-infected population.</description><subject>Adult</subject><subject>AIDS</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Antiretrovirals</subject><subject>Drug therapy</subject><subject>Europe - epidemiology</subject><subject>Female</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV/AIDS</subject><subject>Hospitals</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infections</subject><subject>Latent tuberculosis</subject><subject>Male</subject><subject>Mycobacterium tuberculosis</subject><subject>North America - epidemiology</subject><subject>RNA</subject><subject>Studies</subject><subject>Tuberculosis</subject><subject>Tuberculosis - complications</subject><subject>Tuberculosis - epidemiology</subject><subject>Virology</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkdFqFDEUhgdRbK36BCKpF70bTSaZJHO51NpdKGplLeJNyGTOdLPOJGOSWdw7H90ps7QgiFfnwPfxwzl_lr0k-C3Bkr9jlaSkfJQdk5KKnJcVeTztuJQ5k1QeZc9i3GJMiMTl0-yI8EJKhulx9nvljG3AGUC-ReuxhmDGzkcbke69u0XL1U2-ci2YBA36rJMFlyL6Agbszt5xe7vp9mhhkt0BWrhkA6TgdzboDq03EPSwR9ahizH4AZB2DfroQ9qgRQ_BGv08e9LqLsKLwzzJvn64WJ8v86tPl6vzxVVuSiJTXkiBWxAGeNswwWvG6kZzahiUNa5AQFEXwtQVbhrKQFJcT7sASWrNmcAFPcnO5twh-J8jxKR6Gw10nXbgx6i4nF4jJP2vSAQRoqrEJL75S9z6MbjpCFWQqiplxdhDmgk-xgCtGoLtddgrgtVdc2pubhJfH9LGuofmQTtUNQmns-DH4d8hr2ZnG5MP9xZjnHIuJ5zP2MYEv-6xDj8UF1SUavntu7peF9c39H2hOP0DJVS1uw</recordid><startdate>20051215</startdate><enddate>20051215</enddate><creator>Girardi, Enrico</creator><creator>Sabin, Caroline A</creator><creator>d'Arminio Monforte, Antonella</creator><creator>Hogg, Bob</creator><creator>Phillips, Andrew N</creator><creator>Gill, M John</creator><creator>Dabis, Francois</creator><creator>Reiss, Peter</creator><creator>Kirk, Ole</creator><creator>Bernasconi, Enos</creator><creator>Grabar, Sophie</creator><creator>Justice, Amy</creator><creator>Staszewski, Schlomo</creator><creator>Fätkenheuer, Gerd</creator><creator>Sterne, Jonathan A C</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20051215</creationdate><title>Incidence of Tuberculosis among HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy in Europe and North America</title><author>Girardi, Enrico ; Sabin, Caroline A ; d'Arminio Monforte, Antonella ; Hogg, Bob ; Phillips, Andrew N ; Gill, M John ; Dabis, Francois ; Reiss, Peter ; Kirk, Ole ; Bernasconi, Enos ; Grabar, Sophie ; Justice, Amy ; Staszewski, Schlomo ; Fätkenheuer, Gerd ; Sterne, Jonathan A C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c518t-2870fe7ce6fd476b44bda63c4e5b09e7e2b27cb90dd34e830bb907e81ba647023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>AIDS</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>Antiretrovirals</topic><topic>Drug therapy</topic><topic>Europe - epidemiology</topic><topic>Female</topic><topic>Highly active antiretroviral therapy</topic><topic>HIV</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>HIV/AIDS</topic><topic>Hospitals</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infections</topic><topic>Latent tuberculosis</topic><topic>Male</topic><topic>Mycobacterium tuberculosis</topic><topic>North America - epidemiology</topic><topic>RNA</topic><topic>Studies</topic><topic>Tuberculosis</topic><topic>Tuberculosis - complications</topic><topic>Tuberculosis - epidemiology</topic><topic>Virology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Girardi, Enrico</creatorcontrib><creatorcontrib>Sabin, Caroline A</creatorcontrib><creatorcontrib>d'Arminio Monforte, Antonella</creatorcontrib><creatorcontrib>Hogg, Bob</creatorcontrib><creatorcontrib>Phillips, Andrew N</creatorcontrib><creatorcontrib>Gill, M John</creatorcontrib><creatorcontrib>Dabis, Francois</creatorcontrib><creatorcontrib>Reiss, Peter</creatorcontrib><creatorcontrib>Kirk, Ole</creatorcontrib><creatorcontrib>Bernasconi, Enos</creatorcontrib><creatorcontrib>Grabar, Sophie</creatorcontrib><creatorcontrib>Justice, Amy</creatorcontrib><creatorcontrib>Staszewski, Schlomo</creatorcontrib><creatorcontrib>Fätkenheuer, Gerd</creatorcontrib><creatorcontrib>Sterne, Jonathan A C</creatorcontrib><creatorcontrib>Antiretroviral Therapy Cohort Collaboration</creatorcontrib><creatorcontrib>The Antiretroviral Therapy Cohort Collaboration</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Girardi, Enrico</au><au>Sabin, Caroline A</au><au>d'Arminio Monforte, Antonella</au><au>Hogg, Bob</au><au>Phillips, Andrew N</au><au>Gill, M John</au><au>Dabis, Francois</au><au>Reiss, Peter</au><au>Kirk, Ole</au><au>Bernasconi, Enos</au><au>Grabar, Sophie</au><au>Justice, Amy</au><au>Staszewski, Schlomo</au><au>Fätkenheuer, Gerd</au><au>Sterne, Jonathan A C</au><aucorp>Antiretroviral Therapy Cohort Collaboration</aucorp><aucorp>The Antiretroviral Therapy Cohort Collaboration</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of Tuberculosis among HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy in Europe and North America</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2005-12-15</date><risdate>2005</risdate><volume>41</volume><issue>12</issue><spage>1772</spage><epage>1782</epage><pages>1772-1782</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Background. We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HAART and identified determinants of the incidence. Methods. We analyzed the incidence of TB during the first 3 years after initiation of HAART among 17,142 treatment-naive, AIDS-free persons starting HAART who were enrolled in 12 cohorts from Europe and North America. We used univariable and multivariable Poisson regression models to identify factors associated with the incidence. Results. During the first 3 years (36,906 person-years), 173 patients developed TB (incidence, 4.69 cases per 1000 person-years). In multivariable analysis, the incidence rate was lower for men who have sex with men, compared with injection drug users (relative rate, 2.46; 95% confidence interval [CI], 1.51–4.01), heterosexuals (relative rate, 2.42; 95% CI, 1.64–3.59), those with other suspected modes of transmission (relative rate, 1.66; 95% CI, 0.91–3.06), and those with a higher CD4+ count at the time of HAART initiation (relative rate per log2 cells/µL, 0.87; 95% CI, 0.84–0.91). During 28,846 person-years of follow-up after the first 6 months of HAART, 88 patients developed TB (incidence, 3.1 cases per 1000 person-years of follow-up). In multivariable analyses, a low baseline CD4+ count (relative rate per log2 cells/µL, 0.89; 95% CI, 0.83–0.96), 6-month CD4+ count (relative rate per log2 cells/µL, 0.90; 95% CI, 0.81–0.99), and a 6-month HIV RNA level >400 copies/mL (relative rate, 2.21; 95% CI, 1.33–3.67) were significantly associated with the risk of acquiring TB after 6 months of HAART. Conclusion. The level of immunodeficiency at which HAART is initiated and the response to HAART are important determinants of the risk of TB. However, this risk remains appreciable even among those with a good response to HAART, suggesting that other interventions may be needed to control the TB epidemic in the HIV-infected population.</abstract><cop>United States</cop><pub>The University of Chicago Press</pub><pmid>16288403</pmid><doi>10.1086/498315</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult AIDS Antiretroviral drugs Antiretroviral Therapy, Highly Active Antiretrovirals Drug therapy Europe - epidemiology Female Highly active antiretroviral therapy HIV HIV Infections - complications HIV Infections - drug therapy HIV/AIDS Hospitals Human immunodeficiency virus Humans Incidence Infections Latent tuberculosis Male Mycobacterium tuberculosis North America - epidemiology RNA Studies Tuberculosis Tuberculosis - complications Tuberculosis - epidemiology Virology |
| title | Incidence of Tuberculosis among HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy in Europe and North America |
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