title: Antiretroviral treatment-associated tuberculosis in a prospective cohort of HIV-infected patients starting ART.
abstract: Commencement of antiretroviral treatment (ART) in severely immunosuppressed HIV-infected persons is associated with unmasking of subclinical disease. The subset of patients that are diagnosed with tuberculosis (TB) disease while on ART have been classified as ART-associated TB. Few studies have reported the incidence of ART-associated TB and unmasking TB-IRIS according to the International Network for the Study of HIV-Associated IRIS (INSHI) consensus definition. To determine the incidence and predictors of ART-associated TB, we screened 219 patients commencing ART at the Infectious Diseases Clinic in Kampala, Uganda for TB by symptoms, sputum microscopy, and chest X-rays and followed them for one year. Fourteen (6.4%) patients were diagnosed with TB during followup. Eight (3.8%) patients had ART-associated TB (incidence rate of 4.3 per 100 person years); of these, three patients fulfilled INSHI criteria for unmasking TB-associated IRIS (incidence rate of 1.6 per 100 person years). A body mass index of less than 18.5 kg/m(2) BMI (HR 5.85 95% CI 1.24-27.46, P = .025) and a C-reactive protein greater than 5 mg/L (HR 8.23 95% CI 1.36-38.33, P = .020) were risk factors for ART-associated TB at multivariate analysis. In conclusion, with systematic TB screening (including culture and chest X-ray), the incidence of ART-associated TB is relatively low in settings with high HIV and TB prevalence.
authors.affiliation: Department of Medicine, Mulago Hospital, College of Health Sciences, Makerere University, P.O. Box 7051, Kampala, Uganda. worodria@yahoo.com
authors.forename: William
authors.initials: W
authors.lastname: Worodria
authors.forename: Marguerite
authors.initials: M
authors.lastname: Massinga-Loembe
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja-Kizza
authors.forename: Jane
authors.initials: J
authors.lastname: Namaganda
authors.forename: Andrew
authors.initials: A
authors.lastname: Kambugu
authors.forename: Yukari C
authors.initials: YC
authors.lastname: Manabe
authors.forename: Luc
authors.initials: L
authors.lastname: Kestens
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006678:HIV; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D002097:C-Reactive Protein