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Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART

Muga, Robertoa; Ferreros, Inmaculadab; Langohr, Klausa,c; de Olalla, Patricia Garcíad; del Romero, Jorgee; Quintana, Manuelf; Alastrue, Ignaciog; Belda, Josefinag; Tor, Jordia; Pérez-Hoyos, Santiagob; del Amo, Juliah,i; the Spanish Multicenter Study Group of Seroconverters (GEMES)

doi: 10.1097/QAD.0b013e3282f1c933
Epidemiology and Social

Objective: To analyse incidence and determinants of tuberculosis in HIV-seroconverters before and after the introduction of HAART.

Methods: Data from a multicenter cohort study of 2238 HIV-seroconverters between the 1980s and 2004 were analysed and censored by December 2004. Calendar year at risk intervals were pre-1992, 1992–1996 and 1997–2004. Incident tuberculosis was calculated as cases per 1000 person-years (p-y). Survival analyses using Kaplan–Meier and multivariate Cox regression allowing for late-entry were used. Proportional hazards assumptions were checked with tests based on Schoenfeld residuals.

Results: Overall, 173 (7.7%) patients developed tuberculosis over 23 698 p-y at a rate of 7.3 cases per 1000 p-y [95% confidence interval (CI), 6.3–8.5]. Incident tuberculosis was higher in intravenous drug-users (IDUs), 12.3 per 1000 p-y compared with persons infected sexually, 3.8 per 1000 p-y (P < 0.001), and persons with clotting disorders (PCD), 2.7 per 1000 p-y (P < 0.001). A decreasing tuberculosis incidence trend was observed from 1995 in all categories. Highest tuberculosis rates, 44 per 1000 p-y, were observed prior to 1997 in IDUs infected with HIV for 11 years. In multivariable analyses women were less likely to develop tuberculosis [relative hazard (RH), 0.62; 95% CI, 0.41–0.96; P < 0.05) and IDUs were more likely to develop tuberculosis (RH, 3.0; 95% CI, 1.72–5.26, P < 0.001). In the HAART era, the hazard of developing tuberculosis was 70% lower (RH, 0.31; 95% CI, 0.17–0.54; P < 0.001). Before 1997, the risk of tuberculosis increased with time since HIV seroconversion, whereas it remained nearly constant in the HAART era.

Conclusions: Since the mid-1990s important decreases in tuberculosis have been observed in HIV-seroconverters that probably reflect the impact of both HAART and tuberculosis control programmes.

From the aHospital Universitari Germans Trias i Pujol, Badalona, Spain

bEVES (Escuela Valenciana de Estudios en Salud), Valencia, Spain

cDepartment of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain

dAgència de Salut Pública de Barcelona, Barcelona, Spain

eCentro Sanitario Sandoval, Madrid, Spain

fHospital Universitario La Paz, Madrid, Spain

gCentro de información y prevención del SIDA, Valencia, Spain

hDepartamento de Salud Pública, Universidad Miguel Hernández, Alicante, Spain

iCentro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.

* See list of members in Acknowledgements.

Received 30 May, 2007

Revised 9 August, 2007

Accepted 22 August, 2007

Correspondence to Roberto Muga, PhD, MPH, Department of Internal Medicine, Hospital Universitari Germans Trias I Pujol, Badalona, Spain, Ctra. Canyet s/n 08916 Badalona, Barcelona. Spain. E-mail: rmuga.germanstrias@gencat.net

© 2007 Lippincott Williams & Wilkins, Inc.