Whether the incidence of tuberculosis in HIV-positive people
receiving long-term antiretroviral therapy (ART) remains above background
population rates is unclear. We compared tuberculosis incidence in people
receiving ART with background rates in England, Wales, and Northern Ireland.
We analysed a national cohort of HIV-positive individuals
linked to the national tuberculosis register. Tuberculosis incidence in the
HIV-positive cohort (2007-11) was stratified by ethnic origin and time on ART
and compared with background rates (2009). Ethnic groups were defined as
follows: the black African group included all individuals of black African
origin, including those born in the UK and overseas; the white ethnic group
included all white individuals born in the UK and overseas; the south Asian
group included those of Indian, Pakistani, and Bangladeshi origin, born in the
UK and overseas; and the other ethnic group included all other ethnic origins,
including black Afro-Caribbeans.
The HIV-positive cohort comprised 79 919 individuals, in
whom there were 1550 incident cases in 231 664 person-years of observation
(incidence 6·7 cases per 1000 person-years). Incidence of tuberculosis in the
HIV-positive cohort was 13·6 per 1000 person-years in black Africans and 1·7
per 1000 person-years in white individuals. Incidence of tuberculosis during
long-term ART (≥5 years) in black Africans with HIV was 2·4 per 1000
person-years, similar to background rates of 1·9 per 1000 person-years in this
group (rate ratio 1·2, 95% CI 0·96-1·6; p=0·083); but in white individuals with
HIV on long-term ART the incidence of 0·5 per 1000 person-years was higher than
the background rate of 0·04 per 1000 person-years (rate ratio 14·5, 9·4-21·3;
p<0·0001). The increased incidence relative to background in white
HIV-positive individuals persisted when analysis was restricted to person-time
accrued on ART with CD4 counts of at least 500 cells per μL and when white
HIV-positive individuals born abroad were excluded.
Tuberculosis incidence is unacceptably high irrespective of
HIV status in black Africans. In white individuals with HIV, tuberculosis
incidence is significantly higher than background rates in white people despite
long-term ART. Expanded testing and treatment for latent tuberculosis infection
to all HIV-infected adults, irrespective of ART status and CD4 cell count,
might be warranted.
Via: http://goo.gl/3IOp4z Purchase
full article at: http://goo.gl/SRMAeE
By:
- 1Division of Medicine, University College London, London, UK; HIV/STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
- 2HIV/STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
- 3TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
- 4TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Infectious Disease Epidemiology, University College London, London, UK.
- 5TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
- 6Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK.
- 7TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; MRC Clinical Trials Unit and Centre for Infectious Disease Epidemiology, University College London, London, UK.
- 8Division of Medicine, University College London, London, UK.
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