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

BMC Infectious Diseases

卷:19

Uma Mahajan¹  Sachin Kore²  Niranjan Rathod³  Mahenderkumar Medisetty⁴  Raviraj Gawali⁴  Kartik Natarajan⁴  Ameet Dravid⁵  Milind Kulkarni⁵  Mrudula Dravid⁶  Charuta Ghanekar⁷  Chinmay Saraf⁸ 

[1] Department of Biostatistics, Precision Diagnostics and Biosciences;

[2] Department of Dermatology, Ashwini Sahakari Rugnalaya and Research Centre;

[3] Department of Medicine, Apex hospital;

[4] Department of Medicine, Poona Hospital and Research Centre;

[5] Department of Medicine, Ruby Hall Clinic;

[6] Department of Microbiology, Infectious Disease Clinic;

[7] Department of Microbiology, Poona Hospital and Research Centre;

[8] Department of Pathology, Precision Diagnostics and Biosciences;

关键词: Incident tuberculosis;    HIV;    India;    Private healthcare sector;    Antiretroviral therapy;    Isoniazid preventive therapy;   

DOI  :  10.1186/s12879-019-4361-0

来源: DOAJ

【 摘 要 】

Abstract 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/mm3 (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.

【 授权许可】

Unknown