Tuberculosis after HAART initiation in HIV-positive patients from five countries with a high tuberculosis burden.
BACKGROUND
HAART reduces tuberculosis (TB) incidence in people living with HIV/AIDS but those starting HAART may develop active TB or subclinical TB may become apparent in the immune reconstitution inflammatory syndrome.


OBJECTIVE
To measure the incidence rate of notified TB in people receiving HAART in five HIV programmes occurring in low-resource countries with a high TB/HIV burden.


METHODS
A retrospective review in five Médecins Sans Frontières programmes (Cambodia, Thailand, Kenya, Malawi and Cameroon) allowed incidence rates of notified TB to be calculated based on follow-up time after HAART initiation.


RESULTS
Among 3151 patients analysed, 90% had a CD4 cell count of < 200 cells/mul. Median follow-up time ranged from 3.7 months in Thailand or Kenya to 11.1 months in Cambodia. Incidence rates were 7.6, 10.4, 17.6, 14.3 and 4.8/100 person-years for pulmonary TB and 12.7, 4.3, 6.9, 2.1 and 0/100 person-years for extra-pulmonary TB in the programmes in Cambodia, Thailand, Kenya, Malawi and Cameroon, respectively. Overall, 62.3% of pulmonary TB and 54.9% of extra-pulmonary TB were diagnosed within 3 months after HAART initiation.


CONCLUSIONS
High incidence rates of notified TB under HAART in programmes held in poor-resource countries were observed; these were likely to include both undiagnosed prevalent TB at HAART initiation and subclinical TB developing during the immune reconstitution inflammatory syndrome. This raises operational issues concerning TB diagnosis and treatment of TB/HIV-coinfected patients and prompts for urgent TB and HIV care integration.
Bonnet
Maryline M B
MM
MSF Epicentre, Médecins Sans Frontieres, Paris, France. maryline.bonnet@geneva.msf.org
Pinoges
Loretxu L P
LL
Varaine
Francis F V
FF
Oberhauser
Barbara B O
BB
O'Brien
Daniel D O
DD
Kebede
Yared Y K
YY
Hewison
Cathy C H
CC
Zachariah
Rony R Z
RR
Ferradini
Laurent L F
LL
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use*; D002160:Cambodia; D002163:Cameroon; D016001:Confidence Intervals; D003906:Developing Countries; D019353:Endemic Diseases; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000382:microbiology*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007630:Kenya; D008295:Malawi; D008297:Male; D013785:Thailand; D013997:Time Factors; D014376:Tuberculosis / Q000150:complications*
D000998:Antiviral Agents