The incidence of tuberculosis among hiv-positive individuals with high CD4 counts: implications for policy.
Intensified case finding (ICF) and earlier antiretroviral therapy (ART) initiation are strategies to reduce burden of HIV-associated tuberculosis (TB). We describe incidence of and associated factors for TB among HIV-positive individuals with CD4 counts > 350 cells/μl in South Africa.



Prospective cohort study of individuals recruited for a TB vaccine trial. Eligible individuals without prevalent TB were followed up at 6 and 12 months after enrolment. Cox proportional hazards regression was used to determine factors associated with risk of incident TB.



Six hundred thirty-four individuals were included in the analysis [80.9 % female, 57.9 % on ART, median CD4 count 562 cells/μl (IQR 466-694 cells/μl)]. TB incidence was 2.7 per 100 person-years (pyrs) (95 % CI 1.6-4.4 per 100 pyrs) and did not differ significantly between those on ART and those not on ART [HR 0.65 (95 % CI 0.24-1.81)]. Low body mass index (BMI <18.5 kg/m(2)) was associated with incident TB [HR 3.87 (95 % CI 1.09-13.73)]. Half of the cases occurred in the first 6 months of follow up and may have been prevalent or incubating cases at enrolment.



TB incidence was high and associated with low BMI. Intensified case finding for TB should be strengthened for all HIV positive individuals regardless of their CD4 count or ART status.
The Aurum Institute, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa. tendesayikc@nicd.ac.za.|The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. tendesayikc@nicd.ac.za.
Tendesayi
T
Kufa
The Aurum Institute, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa.|The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Violet
V
Chihota
Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa.
Victor
V
Mngomezulu
The Aurum Institute, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa.|The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Salome
S
Charalambous
KNCV Tuberculosis Foundation, The Hague, The Netherlands.|Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Suzanne
S
Verver
The Aurum Institute, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa.|The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Gavin
G
Churchyard
Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Martien
M
Borgdorff
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology*
D019380:Anti-HIV Agents
Antiretroviral; Case; Finding; Intensified; Therapy