Incidence and Risk Factors for Tuberculosis in People Living with HIV: Cohort from HIV Referral Health Centers in Recife, Brazil

Centro de Pesquisas Aggeu Magalhães/Fiocruz, Recife, Brazil.
PLoS ONE (Impact Factor: 3.23). 05/2013; 8(5):e63916. DOI: 10.1371/journal.pone.0063916
Source: PubMed


To identify the incidence of and risk factors for tuberculosis in people living with HIV (PLHIV).
Observational, prospective cohort study.
A total of 2069 HIV-infected patients was observed between July 2007 and December 2010. The Kaplan-Meier method was used to estimate the probability of survival free of tuberculosis, and Cox regression analysis to identify risk factors associated with the development of tuberculosis.
Survival free of tuberculosis (TB) was 91%. The incidence rate of tuberculosis was 2.8 per 100 persons/years. Incidence of tuberculosis was higher when subjects had CD4 cell count <200 cells/mm(3); were not on antiretroviral therapy; in those who had, a body mass index <18.5 kg/m(2), anemia (or were not tested for it), were illiterate or referred previous tuberculosis treatment at entry into the cohort. Those not treated for latent TB infection had a much higher risk (HR = 7.9) of tuberculosis than those with a negative tuberculin skin test (TST). Having a TST≥5 mm but not being treated for latent TB infection increased the risk of incident tuberculosis even in those with a history of previous tuberculosis.
Preventive actions to reduce the risk of TB in people living with HIV should include an appropriate HAART and treatment for latent TB infection in those with TST≥5 mm. The actions towards enabling rigorous implementation of treatment of latent TB infection and targeting of PLHIV drug users both at the individual and in public health level can reduce substantially the incidence of TB in PLHIV.

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Available from: Laura C Rodrigues, Feb 17, 2014
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    ABSTRACT: Citation: Agbaji O, Ebonyi AO, Meloni ST, Anejo-Okopi JA, Akanbi MO, et al. (2013) Factors Associated With Pulmonary Tuberculosis-HIV Co-Infection in Treatment-Naive Adults in Jos, North Central Nigeria. J AIDS Clin Res 4: 222. Copyright: © 2013 Agbaji O, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
    Journal of AIDS & Clinical Research 07/2013; 4(7). DOI:10.4172/2155-6113.1000222 · 6.83 Impact Factor
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    ABSTRACT: Abstract Background: Study done in Ethiopia in Southern Nation Nationality People (SNNP) during 2003 showed the incidence of TB among those on HAART was lower (3.70 cases of TB per 100 person years) than those, on pre-HAART (11.1 cases of TB per 100 PYO). Besides being on HAART or pre HAART different socio demographic, substance use and clinical factors play an important role in developing TB infection among PLHIV. So, the objective of this study was to assess the effect of HAART on incidence of TB among people living with HIV/AIDS. 1.2 Methods: A retrospective cohort study was conducted at Assela referral Hospital among patients enrolled on HIV care and support during September 13/2005 to January 30/2011. A total of 412 patients’ record from the HAART and pre HAART group were selected in one to one ratio by simple random sampling method. Kaplan Meier and proportional cox regression methods were used to determine the predictor of TB incidence. Result: The incidence of tuberculosis was 7.02/100 person years (95% CI: 5.02, 9.83) among those on pre HAART follow up where as it was 3.73/100 person years among those on HAART. Furthermore, individuals on HAART have a 96.8% decrease in risk of tuberculosis, (AHR=0.032; 95% CI: 0.012, 0.082) than those non-HAART individuals. Similarly CD4 cell count <200 cell/μl and WHO clinical stage III or IV has statistically significant association with TB development among People living with HIV/AIDS. Conclusion and recommendation: HAART use decreased tuberculosis incidence among HIV positive individuals. In addition, CD4 cell count <200 cell/μl and WHO clinical stage III or IV were factors associated with the development of new TB cases among PLHIV. So, HAART should be started with a higher CD4 cell count and none advanced WHO clinical stage in order to get maximum reduction of new TB cases among PLHIV.