TY - JOUR
T1 - Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART
AU - Muga, Roberto
AU - Ferreros, Inmaculada
AU - Langohr, Klaus
AU - De Olalla, Patricia García
AU - Del Romero, Jorge
AU - Quintana, Manuel
AU - Alastrue, Ignacio
AU - Belda, Josefina
AU - Tor, Jordi
AU - Pérez-Hoyos, Santiago
AU - Del Amo, Julia
AU - Aguado, Ildefonso Hernández
AU - Cayla, Joan
AU - Brugal, Teresa
AU - Hurtado, Isabel
AU - Fernández, Elisa
AU - Santos, Concepción
AU - Trullen, Joseph
AU - Sanvisens, Arantza
AU - Clotet, Bonaventura
AU - Rodríguez, Carmen
AU - García, Soledad
AU - Raposo, Montserrat
AU - De Mendoza, Carmen
AU - Soriano, Vicente
AU - Guerrero, Rafael
AU - Andrés Marco, Marco
AU - González, Cristina
AU - Ruiz, Isabel
AU - Tussell, Joan
AU - Pérez, Rosario
AU - Cisneros, José Miguel
PY - 2007/12
Y1 - 2007/12
N2 - OBJECTIVE: To analyse incidence and determinants of tuberculosis in HIV-seroconverters before and after the introduction of HAART. METHODS: Data from a multicenter cohort study of 2238 HIV-seroconverters between the 1980s and 2004 were analysed and censored by December 2004. Calendar year at risk intervals were pre-1992, 1992-1996 and 1997-2004. Incident tuberculosis was calculated as cases per 1000 person-years (p-y). Survival analyses using Kaplan-Meier and multivariate Cox regression allowing for late-entry were used. Proportional hazards assumptions were checked with tests based on Schoenfeld residuals. RESULTS: Overall, 173 (7.7%) patients developed tuberculosis over 23 698 p-y at a rate of 7.3 cases per 1000 p-y [95% confidence interval (CI), 6.3-8.5]. Incident tuberculosis was higher in intravenous drug-users (IDUs), 12.3 per 1000 p-y compared with persons infected sexually, 3.8 per 1000 p-y (P < 0.001), and persons with clotting disorders (PCD), 2.7 per 1000 p-y (P < 0.001). A decreasing tuberculosis incidence trend was observed from 1995 in all categories. Highest tuberculosis rates, 44 per 1000 p-y, were observed prior to 1997 in IDUs infected with HIV for 11 years. In multivariable analyses women were less likely to develop tuberculosis [relative hazard (RH), 0.62; 95% CI, 0.41-0.96; P < 0.05) and IDUs were more likely to develop tuberculosis (RH, 3.0; 95% CI, 1.72-5.26, P < 0.001). In the HAART era, the hazard of developing tuberculosis was 70% lower (RH, 0.31; 95% CI, 0.17-0.54; P < 0.001). Before 1997, the risk of tuberculosis increased with time since HIV seroconversion, whereas it remained nearly constant in the HAART era. CONCLUSIONS: Since the mid-1990s important decreases in tuberculosis have been observed in HIV-seroconverters that probably reflect the impact of both HAART and tuberculosis control programmes.
AB - OBJECTIVE: To analyse incidence and determinants of tuberculosis in HIV-seroconverters before and after the introduction of HAART. METHODS: Data from a multicenter cohort study of 2238 HIV-seroconverters between the 1980s and 2004 were analysed and censored by December 2004. Calendar year at risk intervals were pre-1992, 1992-1996 and 1997-2004. Incident tuberculosis was calculated as cases per 1000 person-years (p-y). Survival analyses using Kaplan-Meier and multivariate Cox regression allowing for late-entry were used. Proportional hazards assumptions were checked with tests based on Schoenfeld residuals. RESULTS: Overall, 173 (7.7%) patients developed tuberculosis over 23 698 p-y at a rate of 7.3 cases per 1000 p-y [95% confidence interval (CI), 6.3-8.5]. Incident tuberculosis was higher in intravenous drug-users (IDUs), 12.3 per 1000 p-y compared with persons infected sexually, 3.8 per 1000 p-y (P < 0.001), and persons with clotting disorders (PCD), 2.7 per 1000 p-y (P < 0.001). A decreasing tuberculosis incidence trend was observed from 1995 in all categories. Highest tuberculosis rates, 44 per 1000 p-y, were observed prior to 1997 in IDUs infected with HIV for 11 years. In multivariable analyses women were less likely to develop tuberculosis [relative hazard (RH), 0.62; 95% CI, 0.41-0.96; P < 0.05) and IDUs were more likely to develop tuberculosis (RH, 3.0; 95% CI, 1.72-5.26, P < 0.001). In the HAART era, the hazard of developing tuberculosis was 70% lower (RH, 0.31; 95% CI, 0.17-0.54; P < 0.001). Before 1997, the risk of tuberculosis increased with time since HIV seroconversion, whereas it remained nearly constant in the HAART era. CONCLUSIONS: Since the mid-1990s important decreases in tuberculosis have been observed in HIV-seroconverters that probably reflect the impact of both HAART and tuberculosis control programmes.
KW - HAART
KW - HIV seroconversion
KW - Population effectiveness
KW - Tuberculosis
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U2 - 10.1097/QAD.0b013e3282f1c933
DO - 10.1097/QAD.0b013e3282f1c933
M3 - Article
C2 - 18025889
AN - SCOPUS:36348990170
SN - 0269-9370
VL - 21
SP - 2521
EP - 2527
JO - AIDS
JF - AIDS
IS - 18
ER -