HIV-associated tuberculosis in the era of highly active antiretroviral therapy. The Adult/Adolescent Spectrum of HIV Disease Group.
OBJECTIVE
To determine the effect of highly active antiretroviral therapy (HAART) on the risk of tuberculosis (TB) among persons infected with the human immunodeficiency virus (HIV), and to examine trends in TB.


METHODS
For the risk factor analysis, we examined data from the Adult/Adolescent Spectrum of HIV Disease (ASD) project from January 1996 through June 1998. ASD is an observational cohort study conducted in over 100 clinics and hospitals in 11 US cities. Poisson regression was used to model the incidence of TB while controlling for HIV-exposure mode, race, country of birth, CD4 count, TB preventive therapy, and half-year of diagnosis. We also examined trends in TB incidence January 1992 to June 1998.


RESULTS
During the risk factor analysis period, 80 cases of TB occurred in 16,032 person-years (5.0 cases/1000 person-years). In multivariate analysis, the risk of TB was much lower among persons prescribed HAART (RR = 0.2, 95%CI 0.1-0.5, P < 0.001), and also lower among persons prescribed other antiretroviral therapy (RR = 0.6, 95% CI 0.4-1.0, P = 0.05), than the risk in persons not prescribed antiretroviral therapy. In addition, TB rates declined from January 1992 to June 1998 (P < 0.001).


CONCLUSIONS
Widespread use of HAART reduced the risk for TB and may help bring about further declines in TB among persons infected with HIV.
Jones
J L
JL
Division of HIV/AIDS Prevention-Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. jlj1@cdc.gov
Hanson
D L
DL
Dworkin
M S
MS
DeCock
K M
KM
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology