title: Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012.
abstract: BACKGROUND
  Nigeria had the most AIDS-related deaths worldwide in 2014 (170,000), and 46% were associated with tuberculosis (TB). Although treatment of people living with HIV (PLHIV) with antiretroviral therapy (ART) reduces TB-associated morbidity and mortality, incident TB can occur while on ART. We estimated incidence and characterized factors associated with TB after ART initiation in Nigeria.
  
  
  METHODS
  We analyzed retrospective cohort data from a nationally representative sample of adult patients on ART. Data were abstracted from 3,496 patient records, and analyses were weighted and controlled for a complex survey design. We performed domain analyses on patients without documented TB disease and used a Cox proportional hazard model to assess factors associated with TB incidence after ART.
  
  
  RESULTS
  At ART initiation, 3,350 patients (95.8%) were not receiving TB treatment. TB incidence after ART initiation was 0.57 per 100 person-years, and significantly higher for patients with CD4<50/μL (adjusted hazard ratio [AHR]: 4.2, 95% confidence interval [CI]: 1.4-12.7) compared with CD4≥200/μL. Patients with suspected but untreated TB at ART initiation and those with a history of prior TB were more likely to develop incident TB (AHR: 12.2, 95% CI: 4.5-33.5 and AHR: 17.6, 95% CI: 3.5-87.9, respectively).
  
  
  CONCLUSIONS
  Incidence of TB among PLHIV after ART initiation was low, and predicted by advanced HIV, prior TB, and suspected but untreated TB. Study results suggest a need for improved TB screening and diagnosis, particularly among high-risk PLHIV initiating ART, and reinforce the benefit of early ART and other TB prevention efforts.
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Atlanta, GA, United States of America.|Epidemic Intelligence Service, U.S. Centers for Disease Control & Prevention, Atlanta, GA, United States of America.
authors.forename: Ishani
authors.identifier: http://orcid.org/0000-0001-8815-2129
authors.initials: I
authors.lastname: Pathmanathan
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Atlanta, GA, United States of America.
authors.forename: E Kainne
authors.initials: EK
authors.lastname: Dokubo
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Atlanta, GA, United States of America.
authors.forename: Ray W
authors.initials: RW
authors.lastname: Shiraishi
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Atlanta, GA, United States of America.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Agolory
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Atlanta, GA, United States of America.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Auld
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria.
authors.forename: Dennis
authors.initials: D
authors.lastname: Onotu
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria.
authors.forename: Solomon
authors.initials: S
authors.lastname: Odafe
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dalhatu
authors.affiliation: Department of Nursing, University of South Alabama, Mobile, AL, United States of America.
authors.forename: Oseni
authors.initials: O
authors.lastname: Abiri
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Debem
authors.affiliation: HIV/AIDS Division, Federal Ministry of Health, Abuja, Nigeria.
authors.forename: Adebobola
authors.initials: A
authors.lastname: Bashorun
authors.affiliation: Division of Global HIV and TB, U.S. Centers for Disease Control & Prevention, Atlanta, GA, United States of America.
authors.forename: Tedd
authors.initials: T
authors.lastname: Ellerbrock
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents