title: Risk of tuberculosis following HIV seroconversion in high-income countries.
abstract: BACKGROUND
  Few data exist on tuberculosis (TB) incidence according to time from HIV seroconversion in high-income countries and whether rates following initiation of a combination of antiretroviral treatments (cARTs) differ from those soon after seroconversion.
  
  
  METHODS
  Data on individuals with well estimated dates of HIV seroconversion were used to analyse post-seroconversion TB rates, ending at the earliest of 1 January 1997, death or last clinic visit. TB rates were also estimated following cART initiation, ending at the earliest of death or last clinic visit. Poisson models were used to examine the effect of current and past level of immunosuppression on TB risk after cART initiation.
  
  
  RESULTS
  Of 19 815 individuals at risk during 1982-1996, TB incidence increased from 5.89/1000 person-years (PY) (95% CI 3.77 to 8.76) in the first year after seroconversion to 10.56 (4.83 to 20.04, p=0.01) at 10 years. Among 11 178 TB-free individuals initiating cART, the TB rate in the first year after cART initiation was 4.23/1000 PY (3.07 to 5.71) and dropped thereafter, remaining constant from year 2 onwards averaging at 1.64/1000 PY (1.29 to 2.05). Current CD4 count was inversely associated with TB rates, while nadir CD4 count was not associated with TB rates after adjustment for current CD4 count, HIV-RNA at cART initiation.
  
  
  CONCLUSIONS
  TB risk increases with duration of HIV infection in the absence of cART. Following cART initiation, TB incidence rates were lower than levels immediately following seroconversion. Implementation of current recommendations to prevent TB in early HIV infection could be beneficial.
authors.affiliation: Clinical Trials Unit, Medical Research Council, London, UK. slodi@isciii.es
authors.forename: Sara
authors.initials: S
authors.lastname: Lodi
authors.forename: Julia
authors.initials: J
authors.lastname: del Amo
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.forename: Sophie
authors.initials: S
authors.lastname: Abgrall
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.forename: Charles
authors.initials: C
authors.lastname: Morrison
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology; D017954:Africa South of the Sahara / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002170:Canada / Q000453:epidemiology; D060085:Coinfection; D019049:Developed Countries / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D016012:Poisson Distribution; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral