Incident tuberculosis in people with HIV across Europe from 2012 to 2022: incidence rates, risk factors and regional differences in a multicentre cohort study
The aim of this study is to describe the incidence of TB, evaluate the impact of modifiable risk factors, in particular being off antiretroviral therapy and smoking and to calculate their population attributable fractions (PAF) in a European cohort of People with HIV (”RESPOND”).
This was a longitudinal study of people with HIV aged ≥18 years with follow-up from either 1 January 2012 or cohort enrolment until date of a TB diagnosis, date of last visit, death or 31 December 2022. Factors associated with TB, in particular antiretroviral therapy status and smoking, were analyzed using multivariable Poisson regression.
With more than 38’000 people with HIV under follow-up, the incidence rate of TB has been declining across all regions, albeit persisting with higher incidence rates in Eastern European countries. Although the TB incidence rate decreased significantly in Eastern Europe over the past 11 years, in 2022 it was still higher than the overall (or Non-Eastern) European incidence rate in 2012. Notably, approximately at least one third of all TB cases in both Non-Eastern and Eastern Europe can be attributed to being off antiretroviral therapy. Moreover, on a population level about 30% of TB cases in Eastern Europe and a tenth in Non-Eastern Europe can be linked to a non-HIV related risk factor, smoking, highlighting the interaction between modifiable risk factors and non-communicable diseases, HIV and TB.
The authors conclude that the overall TB incidence rate among people with HIV in Europe has decreased, but remains higher in Eastern European countries compared to Non-Eastern European countries. Lack of antiretroviral therapy contributes to a significant proportion of TB cases among those with HIV. Strengthening healthcare to provide early initiation and adherence to antiretroviral therapy is the most important intervention for lowering TB incidence by improving immune function and viral suppression. Attention should be paid to those with a history of previous TB to prevent recurrences. A substantial proportion of TB risk among people with HIV in Eastern Europe is attributable to smoking, emphasizing the importance of addressing modifiable risk factors for non-communicable diseases to reduce TB incidence rates.