HIV replication and tuberculosis risk among people living with HIV in Europe: A multicohort analysis, 1983–2015
This study investigated the role of ongoing HIV replication as an independent risk factor for tuberculosis (TB) among individuals living with HIV in Europe. Drawing on data from 25 European cohorts, the researchers analyzed records of 272’548 people who had enrolled in HIV care between 1983 and 2015.
Over a total of 1.9 million person-years of follow-up, 5’956 participants developed TB, resulting in an overall TB incidence of 3.1 cases per 1’000 person-years. The study found a clear association between higher levels of HIV-RNA—indicating ongoing HIV replication—and increased risk of TB, regardless of CD4 cell count. Specifically, individuals with HIV-RNA levels above 10’000 copies/mL had a 4x greater risk of developing TB compared to those with viral loads under 400 copies/mL. This association held true across all CD4 strata and geographic backgrounds.
The findings also showed that individuals born in TB-endemic regions, such as sub-Saharan Africa and Asia, were at substantially higher risk of TB, even when receiving HIV care in Europe. Notably, even people with high CD4 cell counts were vulnerable to TB if their HIV replication was not adequately controlled.
In conclusion, the study highlights that HIV viral load is a critical and independent predictor of TB risk among people living with HIV. It underscores the importance of effective antiretroviral therapy (ART) to suppress viral replication and recommends prioritizing TB preventive therapy and clinical monitoring for individuals, especially those from high-burden TB regions. These findings support existing guidelines advocating for early initiation and consistent management of ART, as well as targeted TB prevention efforts in at-risk populations.