title: Antiretroviral therapy and TB notification rates in a high HIV prevalence South African community.
abstract: BACKGROUND
  Antiretroviral therapy (ART) has been proposed as an intervention for reducing tuberculosis (TB) burdens in areas with high HIV prevalence. However, little data is available on the impact of ART on population-level TB.
  
  
  METHODS
  Trends in adult TB case fatality and notifications were assessed before and during increasing ART coverage in a well-defined periurban community, from 1997 to 2008. Mean changes in TB rates were measured using linear autoregression models. ART coverage increased from 1% in 2003 to 5%, 13%, and 21% of HIV-infected population in 2004, 2005, and 2008, respectively.
  
  
  RESULTS
  From 1997 to end of 2004 TB notification rates increased by an average of 187 cases/100,000/year (P < 0.001), reaching a peak of 2536/100,000 in 2005. From 2005 to 2008, TB notification rates declined by approximately 202 cases/100,000/year (P < 0.001). TB rates were initially stable in HIV-uninfected individuals, but declined moderately from 2005. TB rates declined in HIV-infected adults from 6513/100,000 in 2005 to 4741/100,000 in 2008. The predominant decline in TB notifications occurred among HIV-infected patients receiving ART (1156 cases/100,000/year) and was less marked in those not receiving ART (416 cases/100,000/year). Similarly, TB case fatality was constant for HIV-uninfected individuals, but declined in HIV-infected individuals from 23% in 2002 to 8% in 2008 (P = 0.01).
  
  
  CONCLUSIONS
  In this community heavily affected by both HIV and TB epidemics, rapid and high ART coverage was associated with significant reductions in TB notifications and TB-associated case fatality.
authors.affiliation: Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa. keren.middlekoop@hiv-research.org.za
authors.forename: Keren
authors.initials: K
authors.lastname: Middelkoop
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.forename: Leigh F
authors.initials: LF
authors.lastname: Johnson
authors.forename: Matthew
authors.initials: M
authors.lastname: Kloos
authors.forename: Carl
authors.initials: C
authors.lastname: Morrow
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018563:Disease Notification / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*
chemical_list: D019380:Anti-HIV Agents