Predictors of tuberculosis in first 6 months after initiation of antiretroviral therapy: a case-control study.
METHODS
In Africa, 10% of human immunodeficiency virus (HIV) infected adults starting antiretroviral therapy (ART) die within the first year, and tuberculosis (TB) is the leading cause of death.


OBJECTIVE
To investigate the predictors of ART-associated TB at an adult HIV clinic  in Tanzania.


METHODS
In this nested case-control study, adults starting ART were screened for TB according to the World Health Organization protocol. Those not diagnosed with TB were observed for 6 months. Patients diagnosed with TB were defined as cases, and controls were selected from  among the patients who did not develop TB using incidence density matching.


RESULTS
Among the 2514 HIV-positive adults in our cohort, 72 (3%) were diagnosed with TB during the first 6 months of ART. By multivariate analysis, baseline characteristics predictive of TB were cough, fever and  night sweats; 76% (55/72) of the cases had at least one of these symptoms at the time of starting ART.


CONCLUSIONS
Overall, 75% of the patients who developed TB during the first 6 months of ART had TB symptoms at the time of starting ART. Improved TB diagnostics and/or better strategies  for empirical anti-tuberculosis treatment are needed for patients with symptoms of TB at ART initiation.
Department of Medicine, Bugando Medical Center, Mwanza, Tanzania. rnp2002@med.cornell.edu
R N
RN
Peck
A
A
Luhanga
S
S
Kalluvya
J
J
Todd
S
S
Lugoba
D W
DW
Fitzgerald
J A
JA
Downs
D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000995:Antitubercular Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D060085:Coinfection; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents