Incidence of Tuberculosis Among HIV-Positive Individuals Initiating Antiretroviral Treatment at Higher CD4 Counts in the HPTN 071 (PopART) Trial in South Africa

Böck, Peter; Jennings, Karen; Vermaak, Redwaan; Cox, Helen; Meintjes, Graeme; Fatti, Geoffrey; Kruger, James; Azevedo, Virginia De; Maschilla, Leonard; Louis, Francoise; Gunst, Colette; Grobbelaar, Nelis; Dunbar, Rory; Limbada, Mohammed; Floyd, Sian; Grimwood, Ashraf; Ayles, Helen; Hayes, Richard; Fidler, Sarah; Beyers, Nulda

doi:10.1097/qai.0000000000001560

Cited by 25 publications

(21 citation statements)

References 26 publications

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“…Those patients starting ART at CD4 > 500 cells/mm 3 had the lowest risk of incident TB (0.32 cases per 100 person years). These findings were similar to that seen in study conducted by Bock et al [42] in which TB incidence after ART initiation was significantly lower among individuals starting ART at CD4 counts above 500 cells/mL.…”

Section: Discussionsupporting

confidence: 92%

Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India

Dravid

Natarajan²,

Medisetty³

et al. 2019

BMC Infect Dis

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Background Despite rapid scale up of antiretroviral therapy (ART), Tuberculosis (TB) remains the commonest opportunistic infection and cause of death among HIV infected individuals in resource limited settings like India. Incidence of TB in individuals on ART in private healthcare sector in India is infrequently studied. Methods This retrospective cohort study conducted between 1st March 2009 and 1st March 2017 aimed to evaluate rate of incident TB in individuals initiated on ART at 3 private sector ART clinics in Pune, India. Individuals more than 12 years of age with ART duration of atleast 6 months were included. Patients were classified as having prevalent TB if they had a TB episode within the year prior to ART initiation or if they developed TB within 6 months of starting ART. Individuals who were diagnosed with TB after 6 months of starting ART were classified as incident TB cases. A recurrent episode of TB after treatment completion or cure of prevalent TB was also regarded as incident TB. Patients were classified as definitive TB if Mycobacterium tuberculosis was grown in culture from a biological sample or a positive rapid molecular test. Patients were classified as probable TB if there was radiologic evidence of TB in absence of confirmatory culture or PCR. Results 1904 patients with a median duration of follow up on ART of 57 (IQR = 32.0, 84.0) months were included. Of these, 182 developed incident TB (22% definitive TB, 38% recurrent cases). TB incidence at 6–12 months, 13–24 months, 25–60 months and > 60 months of ART was 24.32, 5.46, 2.54 and 0.75 cases per 100 person years respectively. Current time updated CD4 count < 500 cells/mm 3 ( p < 0.0001), virologic failure on ART (adjusted Hazard Ratio (aHR): 3.05 (95% CI: 2.094, 4.454), p < 0.0001) and receipt of ART without IPT (aHR: 8.24 (95% CI, 3.358, 20.204), p < 0.0001) were associated with higher risk of incident TB. Conclusion Starting ART early in treatment naïve individuals, prompt detection of virologic failure on ART and providing IPT along with ART will be useful in reducing incident TB. Efforts from private sector are crucial in achieving Sustainable Development Goals set by Government of India and attaining the vision of a TB free India.

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Section: Discussionsupporting

confidence: 92%

Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India

Dravid

Natarajan²,

Medisetty³

et al. 2019

BMC Infect Dis

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“…In addition, we have demonstrated that there was no statistically significant difference on the incidence rate of TB in those who achieved viral suppression when compared with those who failed to attain viral suppression. Taken together, the findings suggest that, despite effective viral suppression after initiation of ART, CD4 recovery is suboptimal and eventually resulting in a residual risk of developing TB [38,39]. Indeed, we and others have previously reported that incomplete restoration of Mycobacterium tuberculosis-specific CD4 T-cell responses despite ART [42,43] contributes to increased incidence of TB.…”

Section: Discussionmentioning

confidence: 59%

“…Likewise, in the current study, we found that the median CD4 cell count at the time of TB diagnosis was significantly lower than the counts in those who remained free from TB. Overall, these findings suggest that incident TB developed in the patients whose immunological responses to ART were suboptimal [38,39].…”

Section: Discussionmentioning

confidence: 81%

Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade

Wolday

Kebede

Legesse³

et al. 2020

PLoS ONE

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Background The role of CD4/CD8 ratio on the incidence of tuberculosis (TB) in patients on antiretroviral therapy (ART) is unknown. Thus, we sought to determine whether the CD4/CD8 ratio was associated with development of TB in a cohort of HIV infected individuals on ART followed up for more than a decade in the setting of sub-Saharan Africa (SSA). Methods The cohort comprised adult patients who started ART between 2001 and 2007 and followed for up to 15 years. Clinical data were collected in retrospective manner. Patients with an AIDS defining illness or a CD4 count <200 cell/μL were started with a combination of ART. The participants have clinic visits every 6 months and/or as needed. Poisson regression models were used to identify factors associated with development of incident TB. Kaplan-Meier curves were used to estimate the probability of incident TB while on ART. Results A total of 347 patients with a median duration of follow-up on ART of 11.5 (IQR: 10.0-12.5) years were included. Incident TB developed in 47 patients during the 3259 person-years of follow-up, the majority (76.6%) occurred within five year of ART initiation. On univariate analysis,

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“…64,66,69,71 Tuberculosis incidence is significantly reduced in HIV-positive individuals starting ART with CD4 counts above 500 cells/µl. 73,74 Coupled with early detection, early ART initiation is strongly protective, reducing the risk of active tuberculosis in HIV-infected children. 75…”

Section: Impact Of Hiv On Susceptibility To Tuberculosismentioning

confidence: 99%

Advances in the understanding of Mycobacterium tuberculosis transmission in HIV-endemic settings

Peters

Andrews

Hatherill

et al. 2019

The Lancet Infectious Diseases

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Author's Contributions BK and JP compiled the first draft with input from all authors. All authors were involved in conceiving the overall structure of the review, undertaking literature searches and critically revising drafts. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Incidence of Tuberculosis Among HIV-Positive Individuals Initiating Antiretroviral Treatment at Higher CD4 Counts in the HPTN 071 (PopART) Trial in South Africa

Abstract: Introduction

Cited by 25 publications

References 26 publications

Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India

Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India

Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade

Advances in the understanding of Mycobacterium tuberculosis transmission in HIV-endemic settings

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