Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART

Roberto Muga, Inmaculada Ferreros, Klaus Langohr, Patricia García De Olalla, Jorge Del Romero, Manuel Quintana, Ignacio Alastrue, Josefina Belda, Jordi Tor, Santiago Pérez-Hoyos, Julia Del Amo, Ildefonso Hernández Aguado, Joan Cayla, Teresa Brugal, Isabel Hurtado, Elisa Fernández, Concepción Santos, Joseph Trullen, Arantza Sanvisens, Bonaventura ClotetCarmen Rodríguez, Soledad García, Montserrat Raposo, Carmen De Mendoza, Vicente Soriano, Rafael Guerrero, Marco Andrés Marco, Cristina González, Isabel Ruiz, Joan Tussell, Rosario Pérez, José Miguel Cisneros

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2521-2527
Number of pages7
JournalAIDS
Volume21
Issue number18
DOIs
StatePublished - Dec 1 2007

Keywords

  • HAART
  • HIV seroconversion
  • Population effectiveness
  • Tuberculosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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