Tuberculosis among people living with HIV/AIDS in the German ClinSurv HIV Cohort: long-term incidence and risk factors

BMC Infectious Diseases

Lena Fiebig¹  Osamah Hamouda¹  Barbara Gunsenheimer-Bartmeyer¹  Christian Kollan¹  Walter Haas¹  Basel Karo² 

[1] Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany;Berlin School of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany

关键词: Immigration;    Germany;    Industrialized country;    Isoniazid preventive therapy;    Antiretroviral therapy;    Coinfection;    Tuberculosis;    HIV/AIDS;    Incidence;    Epidemiology;   

Others  :  1134337
DOI  :  10.1186/1471-2334-14-148

 received in 2013-11-15, accepted in 2014-03-07,  发布年份 2014

【 摘 要 】

Background

Tuberculosis (TB) still presents a leading cause of morbidity and mortality among people living with HIV/AIDS (PLWHA), including those on antiretroviral therapy. In this study, we aimed to determine the long-term incidence density rate (IDR) of TB and risk factors among PLWHA in relation to combination antiretroviral therapy (cART)-status.

Methods

Data of PLWHA enrolled from 2001 through 2011 in the German ClinSurv HIV Cohort were investigated using survival analysis and Cox regression.

Results

TB was diagnosed in 233/11,693 PLWHA either at enrollment (N = 62) or during follow-up (N = 171). The TB IDR during follow-up was 0.37 cases per 100 person-years (PY) overall [95% CI, 0.32-0.43], and was higher among patients who never started cART and among patients originating from Sub-Saharan Africa (1.23 and 1.20 per 100PY, respectively). In two multivariable analyses, both patients (I) who never started cART and (II) those on cART shared the same risk factors for TB, namely: originating from Sub-Saharan Africa compared to Germany (I, hazard ratio (HR); [95% CI]) 4.05; [1.87-8.78] and II, HR 5.15 [2.76-9.60], CD4+ cell count <200 cells/μl (I, HR 8.22 [4.36-15.51] and II, HR 1.90 [1.14-3.15]) and viral load >5 log₁₀ copies/ml (I, HR 2.51 [1.33-4.75] and II, HR 1.77 [1.11-2.82]). Gender, age or HIV-transmission risk group were not independently associated with TB.

Conclusion

In the German ClinSurv HIV cohort, patients originating from Sub-Saharan Africa, with low CD4+ cell count or high viral load at enrollment were at increased risk of TB even after cART initiation. As patients might be latently infected with Mycobacterium tuberculosis complex, early screening for latent TB infection and implementing isoniazid preventive therapy in line with available recommendations is crucial.

【 授权许可】

   
2014 Karo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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