Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 77, Issue 1, Pages 93-101Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0000000000001560
Keywords
HIV; antiretroviral treatment; CD4 count; TB
Categories
Funding
- National Institute of Allergy and Infectious Diseases (NIAID) [HPTN 071, UM1-AI068619, UM1-AI068617, UM1-AI068613]
- U. S. President's Emergency Plan for AIDS Relief (PEPFAR)
- International Initiative for Impact Evaluation (3ie)
- Bill & Melinda Gates Foundation
- NIAID, NIH
- National Institute on Drug Abuse (NIDA), NIH
- National Institute of Mental Health (NIMH), NIH
- Wellcome Trust [098316]
- South African Research Chairs Initiative of the Department of Science and Technology
- National Research Foundation (NRF) [64787]
- Medical Research Council [MR/K012126/1] Funding Source: researchfish
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Introduction: Antiretroviral treatment (ART) guidelines recommend life-long ART for all HIV-positive individuals. This study evaluated tuberculosis (TB) incidence on ART in a cohort of HIV-positive individuals starting ART regardless of CD4 count in a programmatic setting at 3 clinics included in the HPTN 071 (PopART) trial in South Africa. Methods: A retrospective cohort analysis of HIV-positive individuals aged >= 18 years starting ART, between January 2014 and November 2015, was conducted. Follow-up was continued until 30 May 2016 or censored on the date of (1) incident TB, (2) loss to follow-up from HIV care or death, or (3) elective transfer out; whichever occurred first. Results: The study included 2423 individuals. Median baseline CD4 count was 328 cells/mu L (interquartile range 195-468); TB incidence rate was 4.41/100 person-years (95% confidence interval [CI]: 3.62 to 5.39). The adjusted hazard ratio of incident TB was 0.27 (95% CI: 0.12 to 0.62) when comparing individuals with baseline CD4 >500 and <= 500 cells/mu L. Among individuals with baseline CD4 count >500 cells/mu L, there were no incident TB cases in the first 3 months of follow-up. Adjusted hazard of incident TB was also higher among men (adjusted hazard ratio 2.16; 95% CI: 1.41 to 3.30). Conclusions: TB incidence after ART initiation was significantly lower among individuals starting ART at CD4 counts above 500 cells/mu L. Scale-up of ART, regardless of CD4 count, has the potential to significantly reduce TB incidence among HIV-positive individuals. However, this needs to be combined with strengthening of other TB prevention strategies that target both HIV-positive and HIV-negative individuals.
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