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Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART.
AIDS. 2007 Nov 30; 21(18):2521-7.AIDS

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.

Authors+Show Affiliations

Hospital Universitari Germans Trias i Pujol, Badalona, Spain. rmuga.germanstrias@gencat.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18025889

Citation

Muga, Roberto, et al. "Changes in the Incidence of Tuberculosis in a Cohort of HIV-seroconverters Before and After the Introduction of HAART." AIDS (London, England), vol. 21, no. 18, 2007, pp. 2521-7.
Muga R, Ferreros I, Langohr K, et al. Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART. AIDS. 2007;21(18):2521-7.
Muga, R., Ferreros, I., Langohr, K., de Olalla, P. G., Del Romero, J., Quintana, M., Alastrue, I., Belda, J., Tor, J., Pérez-Hoyos, S., & Del Amo, J. (2007). Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART. AIDS (London, England), 21(18), 2521-7.
Muga R, et al. Changes in the Incidence of Tuberculosis in a Cohort of HIV-seroconverters Before and After the Introduction of HAART. AIDS. 2007 Nov 30;21(18):2521-7. PubMed PMID: 18025889.
* Article titles in AMA citation format should be in sentence-case
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 - ,, PY - 2007/11/21/pubmed PY - 2008/1/17/medline PY - 2007/11/21/entrez SP - 2521 EP - 7 JF - AIDS (London, England) JO - AIDS VL - 21 IS - 18 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. SN - 1473-5571 UR - https://www.unboundmedicine.com/medline/citation/18025889/Changes_in_the_incidence_of_tuberculosis_in_a_cohort_of_HIV_seroconverters_before_and_after_the_introduction_of_HAART_ L2 - https://doi.org/10.1097/QAD.0b013e3282f1c933 DB - PRIME DP - Unbound Medicine ER -