Incidence of Tuberculosis amongst HIV positive individuals initiating antiretroviral treatment at higher CD4 counts in the HPTN 071 (PopART) trial in South Africa.
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
INTRODUCTION: Antiretroviral treatment (ART) guidelines recommend lifelong ART for all HIV positive individuals. This study evaluated TB incidence on ART in a cohort of HIV positive individuals starting ART regardless of CD4 count in a programmatic setting at three clinics included in the HPTN 071 (PopART) trial in South Africa. METHODS: A retrospective cohort analysis of HIV-positive individuals aged ≥18 years starting ART, between January 2014 and November 2015, was conducted. Follow up was continued until 30 May 2016 or censored on the date of i) incident TB ii) loss to follow up from HIV care or death or iii) elective transfer out; whichever occurred first. RESULTS: The study included 2423 individuals. Median baseline CD4 count was 328 cells/µL (IQR 195-468), TB incidence rate was 4.41/100 PY (95% CI 3.62-5.39). The adjusted hazard ratio of incident TB was 0.27 (95% CI 0.12 - 0.62) when comparing individuals with baseline CD4 > 500cells/µL and ≤ 500cells/µL. Amongst individuals with baseline CD4 count > 500cells/µL there were no incident TB cases in the first three months of follow up. Adjusted hazard of incident TB was also higher amongst men (aHR 2.16; 95% CI: 1.41 - 3.30). CONCLUSION: TB incidence after ART initiation was significantly lower amongst individuals starting ART at CD4 counts above 500cells/µL. Scale up of ART, regardless of CD4 count, has the potential to significantly reduce TB incidence amongst HIV-positive individuals. However, this needs to be combined with strengthening of other TB prevention strategies that target both HIV positive and HIV negative individuals.
Date Issued
2018-01-01
Date Acceptance
2017-09-18
Citation
Journal of Acquired Immune Deficiency Syndromes, 2018, 77 (1), pp.93-101
ISSN
1525-4135
Publisher
Wolters Kluwer Health, Inc.
Start Page
93
End Page
101
Journal / Book Title
Journal of Acquired Immune Deficiency Syndromes
Volume
77
Issue
1
Copyright Statement
© 2017 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is
properly cited. The work cannot be used commercially without permission from the journal.
properly cited. The work cannot be used commercially without permission from the journal.
Sponsor
National Institutes of Health
National Institutes of Health
National Institutes of Health
National Institutes of Health
Department for International Development (UK) (DFI
Grant Number
UM1AI068619
EPIDVH72
HPTN071 Substudy:Phylo PopART
PO15001410 (UMIAI068619)
N/A
Subjects
Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
HIV
antiretroviral treatment
CD4 count
TB
RECONSTITUTION INFLAMMATORY SYNDROME
ISONIAZID PREVENTIVE THERAPY
DIFFERENTIATED CARE
INFECTION
SETTINGS
SERVICES
RISK
Adolescent
Adult
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
Cohort Studies
Female
HIV Infections
Humans
Incidence
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
South Africa
Tuberculosis
Young Adult
Virology
Publication Status
Published
Date Publish Online
2017-09-29