Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART.
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.
Muga
Roberto
R
Hospital Universitari Germans Trias i Pujol, Badalona, Spain. rmuga.germanstrias@gencat.net
Ferreros
Inmaculada
I
Langohr
Klaus
K
de Olalla
Patricia García
PG
Del Romero
Jorge
J
Quintana
Manuel
M
Alastrue
Ignacio
I
Belda
Josefina
J
Tor
Jordi
J
Pérez-Hoyos
Santiago
S
Del Amo
Julia
J
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*