title: Risk factors for tuberculosis after highly active antiretroviral therapy initiation in the United States and Canada: implications for tuberculosis screening.
abstract: BACKGROUND
  Screening for tuberculosis prior to highly active antiretroviral therapy (HAART) initiation is not routinely performed in low-incidence settings. Identifying factors associated with developing tuberculosis after HAART initiation could focus screening efforts.
  
  
  METHODS
  Sixteen cohorts in the United States and Canada contributed data on persons infected with human immunodeficiency virus (HIV) who initiated HAART December 1995-August 2009. Parametric survival models identified factors associated with tuberculosis occurrence.
  
  
  RESULTS
  Of 37845 persons in the study, 145 were diagnosed with tuberculosis after HAART initiation. Tuberculosis risk was highest in the first 3 months of HAART (20 cases; 215 cases per 100000 person-years; 95% confidence interval [CI]: 131-333 per 100000 person-years). In a multivariate Weibull proportional hazards model, baseline CD4+ lymphocyte count <200, black race, other nonwhite race, Hispanic ethnicity, and history of injection drug use were independently associated with tuberculosis risk. In addition, in a piece-wise Weibull model, increased baseline HIV-1 RNA was associated with increased tuberculosis risk in the first 3 months; male sex tended to be associated with increased risk.
  
  
  CONCLUSIONS
  Screening for active tuberculosis prior to HAART initiation should be targeted to persons with baseline CD4 <200 lymphocytes/mm³ or increased HIV-1 RNA, persons of nonwhite race or Hispanic ethnicity, history of injection drug use, and possibly male sex.
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. timothy.sterling@vanderbilt.edu
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.forename: Bryan
authors.initials: B
authors.lastname: Lau
authors.forename: Jinbing
authors.initials: J
authors.lastname: Zhang
authors.forename: Aimee
authors.initials: A
authors.lastname: Freeman
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bosch
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
authors.forename: Audrey
authors.initials: A
authors.lastname: French
authors.forename: Stephen
authors.initials: S
authors.lastname: Gange
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
authors.forename: M
authors.initials: M
authors.lastname: John Gill
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.forename: Benigno
authors.initials: B
authors.lastname: Rodriguez
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.forename: James J
authors.initials: JJ
authors.lastname: Goedert
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Rosemary G
authors.initials: RG
authors.lastname: McKaig
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: Jennifer
authors.initials: J
authors.lastname: Thorne
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002170:Canada / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents