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Tuberculosis among people with HIV infection in the United Kingdom: opportunities for prevention?

By:

Grant, A.D

Contributor(s):

Publication details: 2009Uniform titles:

AIDS

Online resources:

Summary: OBJECTIVE: Toinvestigate the incidence of, and risk factors for, tuberculosis among HIVclinic attendees in the United Kingdom.DESIGN AND METHODS: Observationalcohort study of 27 868 individuals in the United Kingdom Collaborative HIVCohort collaboration, 1996-2005.RESULTS: Amongindividuals not taking combination antiretroviral therapy (cART), tuberculosisincidence was considerably higher among individuals of black African vs. whiteor other ethnicities {incidence rates 9.9 [95% confidence intervals (CIs) 7.2,12.6], 2.5 [95% CI 1.8, 3.0] and 4.4 [95% CI 2.7, 6.0] episodes per 1000person-years, respectively}. Tuberculosis incidence decreased with time afterstarting cART; among black Africans, incidence was consistently higher andremained substantial (5.3 per 1000 person-years) at 24 months and longer afterstarting cART. The strongest independent risk factors for tuberculosis aftercART start were most recent CD4 cell count: adjusted rate ratios (aRR) 10.65(95% CI 6.11, 18.57), 3.40 (95% CI 2.05, 5.65), 1.77 (95% CI 1.06, 2.96) and1.84 (95% CI 1.09, 3.12) for individuals with CD4 cell counts less than 50,50-199, 200-349 and 350-499 cells/microl, respectively, compared with at least500 cells/microl; and black African vs. white ethnicity [aRR 2.93 (95% CI 1.89,4.54)]. HIV risk group, shorter time on cART, later calendar period andunsuppressed viral load were also independently associated with incident tuberculosis.CONCLUSIONS: Tuberculosisincidence among people attending UK HIV clinics is substantial, particularlyamong those with non-white ethnicity and low CD4 cell counts, even afterstarting cART. Earlier HIV diagnosis is needed in order to implement interventionsto prevent tuberculosis; tuberculosis preventive therapy should be consideredin addition to cART.

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Book	Ferriman information and Library Service (North Middlesex) Shelves	Staff publications for NMDX		Available

NMUH Staff Publications

OBJECTIVE: Toinvestigate the incidence of, and risk factors for, tuberculosis among HIVclinic attendees in the United Kingdom.DESIGN AND METHODS: Observationalcohort study of 27 868 individuals in the United Kingdom Collaborative HIVCohort collaboration, 1996-2005.RESULTS: Amongindividuals not taking combination antiretroviral therapy (cART), tuberculosisincidence was considerably higher among individuals of black African vs. whiteor other ethnicities {incidence rates 9.9 [95% confidence intervals (CIs) 7.2,12.6], 2.5 [95% CI 1.8, 3.0] and 4.4 [95% CI 2.7, 6.0] episodes per 1000person-years, respectively}. Tuberculosis incidence decreased with time afterstarting cART; among black Africans, incidence was consistently higher andremained substantial (5.3 per 1000 person-years) at 24 months and longer afterstarting cART. The strongest independent risk factors for tuberculosis aftercART start were most recent CD4 cell count: adjusted rate ratios (aRR) 10.65(95% CI 6.11, 18.57), 3.40 (95% CI 2.05, 5.65), 1.77 (95% CI 1.06, 2.96) and1.84 (95% CI 1.09, 3.12) for individuals with CD4 cell counts less than 50,50-199, 200-349 and 350-499 cells/microl, respectively, compared with at least500 cells/microl; and black African vs. white ethnicity [aRR 2.93 (95% CI 1.89,4.54)]. HIV risk group, shorter time on cART, later calendar period andunsuppressed viral load were also independently associated with incident tuberculosis.CONCLUSIONS: Tuberculosisincidence among people attending UK HIV clinics is substantial, particularlyamong those with non-white ethnicity and low CD4 cell counts, even afterstarting cART. Earlier HIV diagnosis is needed in order to implement interventionsto prevent tuberculosis; tuberculosis preventive therapy should be consideredin addition to cART.

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