title: Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART.
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.affiliation: Hospital Universitari Germans Trias i Pujol, Badalona, Spain. rmuga.germanstrias@gencat.net
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ferreros
authors.forename: Klaus
authors.initials: K
authors.lastname: Langohr
authors.forename: Patricia García
authors.initials: PG
authors.lastname: de Olalla
authors.forename: Jorge
authors.initials: J
authors.lastname: Del Romero
authors.forename: Manuel
authors.initials: M
authors.lastname: Quintana
authors.forename: Ignacio
authors.initials: I
authors.lastname: Alastrue
authors.forename: Josefina
authors.initials: J
authors.lastname: Belda
authors.forename: Jordi
authors.initials: J
authors.lastname: Tor
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez-Hoyos
authors.forename: Julia
authors.initials: J
authors.lastname: Del Amo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission; D006679:HIV Seropositivity; D006467:Hemophilia A / Q000150:complications; D006801:Humans; D008297:Male; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology*