Risk factors for active tuberculosis after antiretroviral treatment initiation in Abidjan.

INSERM U593, Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux, France.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 11.99). 08/2005; 172(1):123-7. DOI: 10.1164/rccm.200410-1342OC
Source: PubMed

ABSTRACT In sub-Saharan Africa: (1) tuberculosis is the first cause of HIV-related mortality; (2) the incidence of tuberculosis in adults receiving highly active antiretroviral therapy (HAART) is lower than in untreated HIV-infected adults but higher than in HIV-negative adults; and (3) factors associated with the occurrence of tuberculosis in patients receiving HAART have never been described.
To look for the risk factors for active tuberculosis in HIV-infected adults receiving HAART in Abidjan.
Seven-year prospective cohort of HIV-infected adults, with standardized procedures for documenting morbidity. We analyzed the incidence of active tuberculosis in patients who started HAART and the association between the occurrence of tuberculosis and the characteristics of these patients at HAART initiation.
A total of 129 adults (median baseline CD4 count 125/mm(3)) started HAART and were then followed for 270 person-years (P-Y). At HAART initiation, 31 had a history of tuberculosis and none had current active tuberculosis. During follow-up, the incidence of active tuberculosis was 4.8/100 P-Y (95% confidence interval [CI], 2.5-8.3) overall, 3.0/100 P-Y (95% CI, 1.1-6.6) in patients with no tuberculosis history, and 11.3/100 P-Y (95% CI, 4.1-24.5) in patients with a history of tuberculosis (adjusted hazard ratio, 4.64; 95% CI, 1.29-16.62, p = 0.02).
The risk of tuberculosis after HAART initiation was significantly higher in patients with a history of tuberculosis than in those with no tuberculosis history. If confirmed by others, this finding could lead to assessment of new patterns of time-limited tuberculosis secondary chemoprophylaxis during the period of initiation of HAART in sub-Saharan African adults.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Knowledge of tuberculosis incidence and associated factors is required for the development and evaluation of strategies to reduce the burden of HIV-associated tuberculosis. Methods: Systematic literature review and meta-analysis of tuberculosis incidence rates among HIV-infected individuals taking combination antiretroviral therapy. Results: From PubMed, EMBASE and Global Index Medicus databases, 42 papers describing 43 cohorts (32 from high/intermediate and 11 from low tuberculosis burden settings) were included in the qualitative review and 33 in the quantitative review. Cohorts from high/intermediate burden settings were smaller in size, had lower median CD4 cell counts at study entry and fewer person-years of follow up. Tuberculosis incidence rates were higher in studies from Sub-Saharan Africa and from World Bank low/middle income countries. Tuberculosis incidence rates decreased with increasing CD4 count at study entry and duration on combination antiretroviral therapy. Summary estimates of tuberculosis incidence among individuals on combination antiretroviral therapy were higher for cohorts from high/intermediate burden settings compared to those from the low tuberculosis burden settings (4.17 per 100 person-years [95% Confidence Interval (CI) 3.39-5.14 per 100 person-years] vs. 0.4 per 100 person-years [95% CI 0.23-0.69 per 100 person-years]) with significant heterogeneity observed between the studies. Conclusions: Tuberculosis incidence rates were high among individuals on combination antiretroviral therapy in high/intermediate burden settings. Interventions to prevent tuberculosis in this population should address geographical, socioeconomic and individual factors such as low CD4 counts and prior history of tuberculosis.
    PLoS ONE 11/2014; 9(11):e111209. DOI:10.1371/journal.pone.0111209 · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This prospective study was conducted to find out the incidence density rate and to identify the attributed risk factors of Tuberculosis development among ART receivers. All patients who were registered in a nodal ART centre of India within 1st January 2008-31st December 2008 and had been initiated ART in the year of 2008 were considered as a cohort and were followed up till 31st December 2012. This study was started with 169 ART receivers and ended with 129 patients. During total 631.1 person-years observation, 39 TB cases (31 pulmonary and 8 extra pulmonary) were diagnosed. TB incidence density rate reduced from 12.08/100 to 1.12/100 person-years during the follow up periods. Cox regression model revealed that patients having past history of Tuberculosis were at 5 times higher risk (Hazard ratio = 5.205; 95 % CI 2.439-11.106; p = 0.000). Patients with WHO clinical stage 3 or 4 at the time of enrolment had 2 times more risk of development of TB (Hazard ratio = 2.081; 95 % CI 1.502-2.884; p = 0.000). This study highlighted that special attention should be paid on earliest identification of TB among the HIV patients who had past history of TB or suffering from WHO clinical stage 3 or 4 to prevent the silent transmission and multidrug resistance development of Tuberculosis in the community.
    Journal of Community Health 07/2014; 39(5). DOI:10.1007/s10900-014-9907-x · 1.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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.

Full-text (2 Sources)

Available from
Jun 5, 2014