Tuberculosis infection and disease in people living with HIV in countries with low tuberculosis incidence

Winter, Joanne R.; AL, Adamu; Rk, Gupta; Delpech, Valérie; Abubakar, Ibrahim

doi:10.5588/ijtld.17.0672

Cited by 16 publications

(13 citation statements)

References 45 publications

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“…In our study, there was a drop of TB incidence (in HIV care) by three-folds following HAART initiation. Patients with higher CD4 and/or CD4/CD8 ratio were at lower risk of TB disease development, as observed in our and previous studies 24,27,28 , as a result of immune recovery 18,19 . The results were consistent with those reported in a study showing the four times higher TB incidence among heterosexual HIV patients not on HAART 29 , and conclusion from a systematic review 19 .…”

Section: Discussionsupporting

confidence: 89%

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Wong

Leung

Chan

et al. 2019

Sci Rep

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Latent TB infection (LTBI) in HIV patients, its treatment, and immunological recovery following highly active antiretroviral therapy (HAART) could interact and impact TB disease progression. We aim to examine the factors associated with LTBI and TB disease development among HIV patients. Longitudinal clinical and laboratory data were accessed from the largest HIV specialist clinic in Hong Kong, where HAART and yearly LTBI screening are routinely provided for HIV patients. Between 2002 and mid-2017, among 2079 HIV patients with 14119 person-years (PY) of follow-up, 32% of LTBI screened patients (n = 1740) were tested positive. The overall TB incidence was 1.26/100 PY from HIV diagnosis to HAART initiation, falling to 0.37/100 PY. A lower risk of TB disease progression was associated with local residence, Chinese ethnicity, negative baseline LTBI result, being on HAART, LTBI treatment, higher baseline CD4 and CD4/CD8 ratio. A positive test at baseline, but not subsequent testing results, was significantly associated with TB disease development. Baseline LTBI screening is an important strategy for identifying HIV patients at risk of TB disease progression. Routine repeat LTBI screening on an annual basis might not give additional benefits to patients on HAART with good immunological responses. Such practice should require re-evaluation.

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Section: Discussionsupporting

confidence: 89%

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Wong

Leung

Chan

et al. 2019

Sci Rep

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“…30 This finding also revealed that patients with severe immunosuppression (CD4% <200 cell/mm3) were 2.12 times higher risk of developing TB than those with higher CD4 in adults. This was consistent with various studies (28,29,32,35,36) in which sever immune suppression fastened the progression of latent TB to active disease (2). This is because HIV kills TB protective immune cells among HIV patients.…”

Section: Discussionsupporting

confidence: 92%

Incidence and Predictors of tuberculosis among HIV patients after initiation of ART treatment in Ethiopia: A systematic review and Meta-analysis

Azanaw

Derseh

Yetemegn

et al. 2019

Preprint

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Background: Tuberculosis is the oldest infectious disease and it is still the leading cause of morbidity and mortality worldwide. Even though, several primary studies have been conducted on incidence of tuberculosis among HIV infected individuals in Ethiopia, national level TB incidence is unknown. Therefore, this systematic review and meta-analysis study is aimed to study TB incidence rate and its predictors among HIV infected individuals in Ethiopia. Methods: We conducted extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, HINARI and Scopus literature. Searching terms used were “incidence”, “predictors”, “Tuberculosis”, “HIV infected patients”, and “Ethiopia”. We used Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument for critical appraisal of studies. The meta-analysis and Meta regressions were conducted using STATA 14 software. The pooled meta-analysis and Meta regression were computed to present the pooled incidence rate and predictors of tuberculosis among HIV infected patients after initiation of ART therapy with a 95% confidence interval Results: Among a total of 189 studies, 11 studies were included in this analysis. The estimated pooled incidence rate of TB per 100-person year observation (PYO) among HIV infected patients after initiation of ART therapy was 4.8(95% CI: 3.69–5.83). In subgroup analysis, the estimated pooled incidence of tuberculosis showed a slightly difference between Adults and children after initiation of ART treatment, which was 4.3 (95% CI: 2.96, 5.71) and 5.0 (95% CI: 3.51, 6.50), respectively. Significant predictor of pooled estimate of meta-analysis showed that being anemic patients (2.30, 95% CI: 1.75, 3.02); on WHO clinical stage III & IV (2.26, 95% CI (1.70, 3.02); and not on CPT (2.16, 95% CI: 1.23, 3.72) and a Meta regression revealed that CD4 <200 cells/mm 3 (2.12, 95% CI: 1.17, 3.86) was positively significant predictors among Adults. Conclusions: The current systematic review and meta-analysis showed that the pooled incidence of TB among HIV patients was found to lower than WHO 2018 national estimate. Being anemic, WHO stage III& IV, not on CPT, CD4 <200cells/µl and being male were significant predictors of Tuberculosis. Therefore, the existing strategies to decrease TB should be strengthening.

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“…Studies by [10] and [11] in various outbreak settings confirm that HIV co-infection does intensify the progression of latent TB to active TB disease. The diagnosis of TB in the HIV epidemic remains extremely challenging because of the difficulty in differentiating between reactivation and recent infections [12]. The risk of infection or reinfection is dependent on the source case numbers in various congregate settings including households and health-care facilities [5].…”

Section: Introductionmentioning

confidence: 99%

Bayesian modeling of spatiotemporal patterns of TB-HIV co-infection risk in Kenya

Otiende¹,

Achia

Mwambi

2019

BMC Infect Dis

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BackgroundTuberculosis (TB) and Human Immunodeficiency Virus (HIV) diseases are globally acknowledged as a public health challenge that exhibits adverse bidirectional relations due to the co-epidemic overlap. To understand the co-infection burden we used the case notification data to generate spatiotemporal maps that described the distribution and exposure hypotheses for further epidemiologic investigations in areas with unusual case notification levels.MethodsWe analyzed the TB and TB-HIV case notification data from the Kenya national TB control program aggregated for forty-seven counties over a seven-year period (2012–2018). Using spatiotemporal poisson regression models within the Integrated Nested Laplace Approach (INLA) paradygm, we modeled the risk of TB-HIV co-infection. Six competing models with varying space-time formulations were compared to determine the best fit model. We then assessed the geographic patterns and temporal trends of coinfection risk by mapping the posterior marginal from the best fit model.ResultsOf the total 608,312 TB case notifications, 194,129 were HIV co-infected. The proportion of TB-HIV co-infection was higher in females (39.7%) than in males (27.0%). A significant share of the co-infection was among adults aged 35 to 44 years (46.7%) and 45 to 54 years (42.1%). Based on the Bayesian Defiance Information (DIC) and the effective number of parameters (pD) comparisons, the spatiotemporal model allowing space-time interaction was the best in explaining the geographical variations in TB-HIV coinfection. The model results suggested that the risk of TB-HIV coinfection was influenced by infrastructure index (Relative risk (RR) = 5.75, Credible Interval (Cr.I) = (1.65, 19.89)) and gender ratio (RR = 5.81e−04, Cr. I = (1.06e−04, 3.18e−03). The lowest and highest temporal relative risks were in the years 2016 at 0.9 and 2012 at 1.07 respectively. The spatial pattern presented an increased co-infection risk in a number of counties. For the spatiotemporal interaction, only a few counties had a relative risk greater than 1 that varied in different years.ConclusionsWe identified elevated risk areas for TB/HIV co-infection and fluctuating temporal trends which could be because of improved TB case detection or surveillance bias caused by spatial heterogeneity in the co-infection dynamics. Focused interventions and continuous TB-HIV surveillance will ensure adequate resource allocation and significant reduction of HIV burden amongst TB patients.

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Tuberculosis infection and disease in people living with HIV in countries with low tuberculosis incidence

Cited by 16 publications

References 45 publications

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Incidence and Predictors of tuberculosis among HIV patients after initiation of ART treatment in Ethiopia: A systematic review and Meta-analysis

Bayesian modeling of spatiotemporal patterns of TB-HIV co-infection risk in Kenya

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