title: Incidence of tuberculosis in HIV-infected patients receiving HAART: interaction between TST and CD4 count.
abstract: BACKGROUND
  There may be an interaction between the CD4 count and the tuberculin skin test (TST) for the development of tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients receiving highly active antiretroviral therapy (HAART).
  
  
  METHODS
  Observational, cohort study of patients treated with HAART during the course of HIV infection in whom TB was confirmed by a positive culture result. Patients were stratified by TST and CD4 count. Univariate and multivariate analyses were performed to identify risk factors associated with the development of TB.
  
  
  RESULTS
  The study included 1824 patients starting HAART, 339 (18.6%) of whom were TST-positive. After a median 473 days, 45 cases of TB had developed (1.9 cases per 100 person-years, 95%CI 1.38-2.54). The risk of developing TB increased significantly among patients with a positive TST (2.81, 95%CI 1.11-7.15), and in individuals with > or < 200 cells/μ l (1.37, 95%CI 0.44-4.21). By contrast, in the TST-negative group, the risk was significantly higher in patients with < 200 cells/μ l (16.64, 95%CI 2.16-127.6).
  
  
  CONCLUSIONS
  TST-positive patients are at high risk of developing TB, irrespective of CD4 count. However, among TST-negative patients only those with a CD4 count < 200 cells/μ l have an appreciable risk of developing the disease.
authors.affiliation: Internal Medicine Service, Hospital Universitario de Guadalajara, Guadalajara. estebanmartinechevarria@yahoo.es
authors.forename: E
authors.initials: E
authors.lastname: Martín-Echevarria
authors.forename: M
authors.initials: M
authors.lastname: Rodríguez-Zapata
authors.forename: M
authors.initials: M
authors.lastname: Torralba
authors.forename: J M R
authors.initials: JM
authors.lastname: Fernández
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.forename: J L
authors.initials: JL
authors.lastname: Casado
authors.forename: F
authors.initials: F
authors.lastname: Dronda
authors.forename: M J
authors.initials: MJ
authors.lastname: Pérez-Elías
authors.forename: E
authors.initials: E
authors.lastname: Navas
authors.forename: S
authors.initials: S
authors.lastname: Moreno
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D060085:Coinfection; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology
chemical_list: D019380:Anti-HIV Agents