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Incidence of Tuberculosis amongst HIV positive individuals initiating antiretroviral treatment at higher CD4 counts in the HPTN 071 (PopART) trial in South Africa.

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Title: Incidence of Tuberculosis amongst HIV positive individuals initiating antiretroviral treatment at higher CD4 counts in the HPTN 071 (PopART) trial in South Africa.
Authors: Bock, P
Jennings, K
Vermaak, R
Cox, H
Meintjes, G
Fatti, G
Kruger, J
Azevedo, V
Maschilla, L
Louis, F
Gunst, C
Grobbelaar, N
Dunbar, R
Limbada, M
Floyd, S
Grimwood, A
Ayles, H
Hayes, R
Fidler, S
Beyers, N
HPTN 071(PopART) team
Item 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.
Issue Date: 1-Jan-2018
Date of Acceptance: 18-Sep-2017
URI: http://hdl.handle.net/10044/1/54410
DOI: https://dx.doi.org/10.1097/QAI.0000000000001560
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.
Sponsor/Funder: National Institutes of Health
National Institutes of Health
National Institutes of Health
National Institutes of Health
Department for International Development (UK) (DFI
Funder's Grant Number: UM1AI068619
EPIDVH72
HPTN071 Substudy:Phylo PopART
PO15001410 (UMIAI068619)
N/A
Keywords: 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
Online Publication Date: 2017-09-29
Appears in Collections:Department of Medicine



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