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doi: 10.1097/QAD.0b013e3282f1c933
Epidemiology and Social

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)

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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.

© 2007 Lippincott Williams & Wilkins, Inc.


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