Risk of tuberculosis after initiation of antiretroviral therapy among persons with HIV in Europe.  International Journal of Infectious Diseases.
On behalf of the RESPOND consortium, Johansen et al. aimed to quantify the risk of tuberculosis (TB) over time and associated risk factors in persons with HIV initiating antiretroviral therapy (ART).
They included individuals enrolled in RESPOND who initiated ART after 1 January 2012 and did not have a prior TB diagnosis. They assessed incidence rates of TB disease including pulmonary and extrapulmonary forms as diagnosed by the treating physicians, and used Poisson regression to calculate incidence rate rations within 6 months after ART initiation.
The 8’441 participants contributed 35’383 person-years of follow-up and 66 TB disease diagnoses (TB incidence rate 1.87/1’000 person-years). The risk was highest within the first 3 months of ART (incidence rate 14.41/1,000 person-years) and declined thereafter (0.51/1’000 person-years >12 months after ART initiation). In multivariable models, African origin, seeking care in Northern or Eastern Europe, having a CD4 cell count <200 cell/mm3 at ART initiation and HIV RNA ≥100,000 copies/ml at ART initiation were associated with a higher rate of TB. Individuals who developed TB disease over 6 months after ART initiation were likely to have a low CD4 count and/or detectable HIV RNA, seek care in Eastern Europe and have a history of injection drug use.
In conclusion, the authors showed that persons with HIV are at increased risk to develop TB compared to the general population in Europe and found a much higher risk during the first months of ART – potentially due to unmasking of previously subclinical TB. The results highlight the importance of assessing TB risk in persons with HIV entering care also in regions with a low prevalence of TB.