title: Predictors of antiretroviral treatment-associated tuberculosis in Ethiopia: a nested case-control study.
abstract: Little is known about the predictors of antiretroviral treatment (ART)-associated tuberculosis (TB) in developing nations. The objective of this study was to determine predictors of ART-associated TB in adults with HIV infection at Jimma University Hospital, Ethiopia. A nested case-control study was conducted in October 2009. The study population consisted of adults with HIV infection (aged >14 years) who developed active TB in the first six months since ART initiation and controls that did not develop active TB. Data were collected using a structured and pretested questionnaire. Cox proportions hazards analysis was done to determine predictors of ART-associated TB. A total of 357 patients (119 cases and 238 controls) participated in the study. After six months of follow-up, cumulative incidence of ART-associated TB was 5.2% (123/2355). Forty (33.6%) cases were lost to follow-up after they developed ART-associated TB and 11 (9.2%) died. Fifty-one (21.4%) controls interrupted ART and 11 (4.6%) died. A CD4 lymphocyte count increase >0.5/μL/day (adjusted hazard ratio [AHR] = 19.80, 95% confidence interval [CI]: 9.52, 41.12, P < 0.001), a base-line CD4 lymphocyte count <200 cells/μL (AHR = 9.59, 95% CI: 2.36, 39.04, P = 0.002), World Health Organization (WHO) clinical stage 3 or 4 (AHR = 3.04, 95% CI: 1.62, 5.69, P < 0.001), night sweats during ART initiation (AHR = 1.53, 95% CI: 1.06, 2.21, P < 0.001) and high ART adherence (AHR = 1.30, 95% CI: 1.13, 1.50, P < 0.001) were independent predictors of ART-associated TB. HIV-infected adults with these risk factors should be followed cautiously for the development of ART-associated TB. Good ART adherence and a good immunological response during ART were associated with ART-associated TB, most likely because of an immune reconstitution inflammatory syndrome unmasking the TB.
authors.affiliation: Department of Internal Medicine, Hawassa University, Hawassa,  Ethiopia.
authors.forename: N
authors.initials: N
authors.lastname: Mesfin
authors.forename: A
authors.initials: A
authors.lastname: Deribew
authors.forename: A
authors.initials: A
authors.lastname: Yami
authors.forename: T
authors.initials: T
authors.lastname: Solomon
authors.forename: J P
authors.initials: JP
authors.lastname: Van Geertruyden
authors.forename: R
authors.initials: R
authors.lastname: Colebunders
mesh_terms: D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005002:Ethiopia / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D016016:Proportional Hazards Models; D012372:ROC Curve; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000139:chemically induced / Q000453:epidemiology / Q000821:virology
chemical_list: D044966:Anti-Retroviral Agents