title: Development of tuberculosis in human immunodeficiency virus infected patients receiving antiretroviral therapy.
abstract: BACKGROUND
  It is unclear whether optimal immunological recovery reduces the risk of tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients receiving antiretroviral therapy (ART), in whom it is still significantly higher than in the general population.
  
  
  METHODS
  Retrospective cohort study in ART-treated patients without a previous diagnosis of TB. TB was microbiologically proven. Multivariate analyses were performed to identify risk factors associated with TB.
  
  
  RESULTS
  This study included 1824 patients; the median follow-up was 473 days. The median CD4 count was 207 cells/μl (90-363.8); 339 (18.6%) were tuberculin skin test positive. Increased CD4 count gain after ART initiation was a protective factor against active TB (per each 100 cells/μl increase, OR 0.683, 95%CI 0.522-0.894). Maximal protection was observed in patients reaching increments ⩾150 cells/μl after 12 months of ART (OR 0.29, 95%CI 0.11-0.8) or ⩾300 cells/μl after 24 months (OR 0.73, 95%CI 0.71-0.75). There was no association between achieving HIV RNA <50 copies/ml and risk of active TB (OR 1.43, 95%CI 0.68-2.49).
  
  
  CONCLUSIONS
  The risk of TB in patients starting ART is reduced among those with better immunological response, and is unrelated to the virological response. Our results emphasise the need for adjunctive strategies in immunological non-responders to minimise any residual risk of TB.
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Guadalajara, Guadalajara, Mexico.
authors.forename: E
authors.initials: E
authors.lastname: Martín-Echevarria
authors.affiliation: Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Serrano-Villar
authors.affiliation: Laboratory of Molecular Immune Biology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Sainz
authors.affiliation: Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Casado
authors.affiliation: Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Dronda
authors.affiliation: Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: M J Pérez
authors.initials: MJ
authors.lastname: Elías
authors.affiliation: Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid.
authors.forename: E
authors.initials: E
authors.lastname: Navas
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Guadalajara, Guadalajara, Mexico.
authors.forename: M Rodríguez
authors.initials: MR
authors.lastname: Zapata
authors.affiliation: Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Moreno
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents