title: High rates of tuberculosis in patients accessing HAART in rural South Africa.
abstract: BACKGROUND
  The challenge of early tuberculosis (TB) infection among rural patients accessing highly active antiretroviral therapy (HAART) in a resource-limited setting with high HIV and TB burden has not been fully quantified.
  
  
  METHODS
  This is a retrospective study nested within a prospective study of 969 patients consecutively initiated onto HAART at the CAPRISA AIDS Treatment programme in rural KwaZulu-Natal between January 2007 and December 2010. Patients were screened for clinical symptoms consistent with TB using a standardized checklist, and routine clinical investigations that included sputum microscopy and chest x-ray diagnosis.
  
  
  RESULTS
  Of 969 HIV-infected patients initiated on HAART, 173 [17.9%; 95% confidence interval (CI): 15.5 to 20.4] had active TB at HAART initiation. TB incidence rates were 3-fold higher in the first 3 months (early incident TB) after HAART initiation [11.5/100 person-years (py); 95% CI: 7.1 to 17.5] compared with 4-24 months (late incident TB) post-HAART initiation (3.2/100 py; 95% CI: 2.2 to 4.5; incidence rate ratio: 3.6; 95% CI: 2.0 to 6.4; P < 0.001). Immune status of patients at HAART initiation did not impact TB incidence rates in patients with CD4 counts of <50 (5.3/100) and >200 (4.9/100 py; P = 0.81) cells per cubic millimeter. CD4 count gains achieved 12 months post-HAART initiation were significantly different in patients with early incident TB versus late incident TB; P = 0.03.
  
  
  CONCLUSIONS
  Rural HIV treatment programmes in TB-endemic settings experience high rates of TB irrespective of immunologic status of patients at HAART initiation, or duration on HAART.
authors.affiliation: *Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and ‡Oxford Department of Public Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Kogieleum
authors.initials: K
authors.lastname: Naidoo
authors.forename: Quarraisha Abdool
authors.initials: QA
authors.lastname: Karim
authors.forename: Ambika
authors.initials: A
authors.lastname: Bhushan
authors.forename: Kasavan
authors.initials: K
authors.lastname: Naidoo
authors.forename: Nonhlanhla
authors.initials: N
authors.lastname: Yende-Zuma
authors.forename: Patricia K
authors.initials: PK
authors.lastname: McHunu
authors.forename: Janet
authors.initials: J
authors.lastname: Frohlich
authors.forename: Farina
authors.initials: F
authors.lastname: Karim
authors.forename: Michele
authors.initials: M
authors.lastname: Upfold
authors.forename: Paul
authors.initials: P
authors.lastname: Kocheleff
authors.forename: Salim S
authors.initials: SS
authors.lastname: Abdool Karim
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012424:Rural Population; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents