Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries

Julia del Amo; Santiago Moreno; Heiner C Bucher; Hansjakob Furrer; Roger Logan; Jonathan Sterne; Santiago Pérez-Hoyos; Inma Jarrín; Andrew Phillips; Sara Lodi; Ard van Sighem; Wolf de Wolf; Caroline Sabin; Loveleen Bansi; Amy Justice; Joseph Goulet; José M Miró; Elena Ferrer; Laurence Meyer; Rémonie Seng; Giota Toulomi; Panagiotis Gargalianos; Dominique Costagliola; Sophie Abgrall; Miguel A Hernán; HIV-CAUSAL Collaboration

doi:10.1093/cid/cis203

Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries

Julia del Amo, Santiago Moreno, Heiner C Bucher, Hansjakob Furrer, Roger Logan, Jonathan Sterne, Santiago Pérez-Hoyos, Inma Jarrín, Andrew Phillips, Sara Lodi, Ard van Sighem, Wolf de Wolf, Caroline Sabin, Loveleen Bansi, Amy Justice, Joseph Goulet, José M Miró, Elena Ferrer, Laurence Meyer, Rémonie SengGiota Toulomi, Panagiotis Gargalianos, Dominique Costagliola, Sophie Abgrall, Miguel A Hernán, HIV-CAUSAL Collaboration

Research output: Contribution to journal › Article (Academic Journal) › peer-review

54 Citations (Scopus)

Abstract

BACKGROUND: The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries.

METHODS: The HIV-CAUSAL Collaboration consisted of 12 cohorts from the United States and Europe of HIV-positive, ART-naive, AIDS-free individuals aged ≥18 years with baseline CD4 cell count and HIV RNA levels followed up from 1996 through 2007. We estimated hazard ratios (HRs) for cART versus no cART, adjusted for time-varying CD4 cell count and HIV RNA level via inverse probability weighting.

RESULTS: Of 65 121 individuals, 712 developed tuberculosis over 28 months of median follow-up (incidence, 3.0 cases per 1000 person-years). The HR for tuberculosis for cART versus no cART was 0.56 (95% confidence interval [CI], 0.44-0.72) overall, 1.04 (95% CI, 0.64-1.68) for individuals aged >50 years, and 1.46 (95% CI, 0.70-3.04) for people with a CD4 cell count of <50 cells/μL. Compared with people who had not started cART, HRs differed by time since cART initiation: 1.36 (95% CI, 0.98-1.89) for initiation <3 months ago and 0.44 (95% CI, 0.34-0.58) for initiation ≥3 months ago. Compared with people who had not initiated cART, HRs <3 months after cART initiation were 0.67 (95% CI, 0.38-1.18), 1.51 (95% CI, 0.98-2.31), and 3.20 (95% CI, 1.34-7.60) for people <35, 35-50, and >50 years old, respectively, and 2.30 (95% CI, 1.03-5.14) for people with a CD4 cell count of <50 cells/μL.

CONCLUSIONS: Tuberculosis incidence decreased after cART initiation but not among people >50 years old or with CD4 cell counts of <50 cells/μL. Despite an overall decrease in tuberculosis incidence, the increased rate during 3 months of ART suggests unmasking IRIS.

Original language	English
Pages (from-to)	1364-72
Number of pages	9
Journal	Clinical Infectious Diseases
Volume	54
Issue number	9
DOIs	https://doi.org/10.1093/cid/cis203
Publication status	Published - May 2012

Keywords

AIDS-Related Opportunistic Infections
Adult
Anti-HIV Agents
CD4 Lymphocyte Count
Cohort Studies
Developed Countries
Drug Therapy, Combination
Europe
Female
HIV Infections
HIV Seropositivity
Humans
Immune Reconstitution Inflammatory Syndrome
Incidence
Male
Middle Aged
Mycobacterium tuberculosis
Pneumocystis jirovecii
Pneumonia, Pneumocystis
RNA, Viral
Tuberculosis
United States
Viral Load

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10.1093/cid/cis203

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ART-CC: Prognosis of HIV-infected patients treated with ART
Sterne, J. A. C., Ingle, S. M. & May, M. T.
1/02/12 → 1/02/15
Project: Research

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del Amo, J., Moreno, S., Bucher, H. C., Furrer, H., Logan, R., Sterne, J., Pérez-Hoyos, S., Jarrín, I., Phillips, A., Lodi, S., van Sighem, A., de Wolf, W., Sabin, C., Bansi, L., Justice, A., Goulet, J., Miró, J. M., Ferrer, E., Meyer, L., ... HIV-CAUSAL Collaboration (2012). Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries. Clinical Infectious Diseases, 54(9), 1364-72. https://doi.org/10.1093/cid/cis203

@article{3b9ef57372044c8cafe429115642a7ce,

title = "Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries",

abstract = "BACKGROUND: The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries.METHODS: The HIV-CAUSAL Collaboration consisted of 12 cohorts from the United States and Europe of HIV-positive, ART-naive, AIDS-free individuals aged ≥18 years with baseline CD4 cell count and HIV RNA levels followed up from 1996 through 2007. We estimated hazard ratios (HRs) for cART versus no cART, adjusted for time-varying CD4 cell count and HIV RNA level via inverse probability weighting.RESULTS: Of 65 121 individuals, 712 developed tuberculosis over 28 months of median follow-up (incidence, 3.0 cases per 1000 person-years). The HR for tuberculosis for cART versus no cART was 0.56 (95% confidence interval [CI], 0.44-0.72) overall, 1.04 (95% CI, 0.64-1.68) for individuals aged >50 years, and 1.46 (95% CI, 0.70-3.04) for people with a CD4 cell count of <50 cells/μL. Compared with people who had not started cART, HRs differed by time since cART initiation: 1.36 (95% CI, 0.98-1.89) for initiation <3 months ago and 0.44 (95% CI, 0.34-0.58) for initiation ≥3 months ago. Compared with people who had not initiated cART, HRs <3 months after cART initiation were 0.67 (95% CI, 0.38-1.18), 1.51 (95% CI, 0.98-2.31), and 3.20 (95% CI, 1.34-7.60) for people <35, 35-50, and >50 years old, respectively, and 2.30 (95% CI, 1.03-5.14) for people with a CD4 cell count of <50 cells/μL.CONCLUSIONS: Tuberculosis incidence decreased after cART initiation but not among people >50 years old or with CD4 cell counts of <50 cells/μL. Despite an overall decrease in tuberculosis incidence, the increased rate during 3 months of ART suggests unmasking IRIS.",

keywords = "AIDS-Related Opportunistic Infections, Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Cohort Studies, Developed Countries, Drug Therapy, Combination, Europe, Female, HIV Infections, HIV Seropositivity, Humans, Immune Reconstitution Inflammatory Syndrome, Incidence, Male, Middle Aged, Mycobacterium tuberculosis, Pneumocystis jirovecii, Pneumonia, Pneumocystis, RNA, Viral, Tuberculosis, United States, Viral Load",

author = "{del Amo}, Julia and Santiago Moreno and Bucher, {Heiner C} and Hansjakob Furrer and Roger Logan and Jonathan Sterne and Santiago P{\'e}rez-Hoyos and Inma Jarr{\'i}n and Andrew Phillips and Sara Lodi and {van Sighem}, Ard and {de Wolf}, Wolf and Caroline Sabin and Loveleen Bansi and Amy Justice and Joseph Goulet and Mir{\'o}, {Jos{\'e} M} and Elena Ferrer and Laurence Meyer and R{\'e}monie Seng and Giota Toulomi and Panagiotis Gargalianos and Dominique Costagliola and Sophie Abgrall and Hern{\'a}n, {Miguel A} and {HIV-CAUSAL Collaboration}",

year = "2012",

month = may,

doi = "10.1093/cid/cis203",

language = "English",

volume = "54",

pages = "1364--72",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "9",

}

del Amo, J, Moreno, S, Bucher, HC, Furrer, H, Logan, R, Sterne, J, Pérez-Hoyos, S, Jarrín, I, Phillips, A, Lodi, S, van Sighem, A, de Wolf, W, Sabin, C, Bansi, L, Justice, A, Goulet, J, Miró, JM, Ferrer, E, Meyer, L, Seng, R, Toulomi, G, Gargalianos, P, Costagliola, D, Abgrall, S, Hernán, MA & HIV-CAUSAL Collaboration 2012, 'Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries', Clinical Infectious Diseases, vol. 54, no. 9, pp. 1364-72. https://doi.org/10.1093/cid/cis203

TY - JOUR

T1 - Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries

AU - del Amo, Julia

AU - Moreno, Santiago

AU - Bucher, Heiner C

AU - Furrer, Hansjakob

AU - Logan, Roger

AU - Sterne, Jonathan

AU - Pérez-Hoyos, Santiago

AU - Jarrín, Inma

AU - Phillips, Andrew

AU - Lodi, Sara

AU - van Sighem, Ard

AU - de Wolf, Wolf

AU - Sabin, Caroline

AU - Bansi, Loveleen

AU - Justice, Amy

AU - Goulet, Joseph

AU - Miró, José M

AU - Ferrer, Elena

AU - Meyer, Laurence

AU - Seng, Rémonie

AU - Toulomi, Giota

AU - Gargalianos, Panagiotis

AU - Costagliola, Dominique

AU - Abgrall, Sophie

AU - Hernán, Miguel A

AU - HIV-CAUSAL Collaboration

PY - 2012/5

Y1 - 2012/5

N2 - BACKGROUND: The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries.METHODS: The HIV-CAUSAL Collaboration consisted of 12 cohorts from the United States and Europe of HIV-positive, ART-naive, AIDS-free individuals aged ≥18 years with baseline CD4 cell count and HIV RNA levels followed up from 1996 through 2007. We estimated hazard ratios (HRs) for cART versus no cART, adjusted for time-varying CD4 cell count and HIV RNA level via inverse probability weighting.RESULTS: Of 65 121 individuals, 712 developed tuberculosis over 28 months of median follow-up (incidence, 3.0 cases per 1000 person-years). The HR for tuberculosis for cART versus no cART was 0.56 (95% confidence interval [CI], 0.44-0.72) overall, 1.04 (95% CI, 0.64-1.68) for individuals aged >50 years, and 1.46 (95% CI, 0.70-3.04) for people with a CD4 cell count of <50 cells/μL. Compared with people who had not started cART, HRs differed by time since cART initiation: 1.36 (95% CI, 0.98-1.89) for initiation <3 months ago and 0.44 (95% CI, 0.34-0.58) for initiation ≥3 months ago. Compared with people who had not initiated cART, HRs <3 months after cART initiation were 0.67 (95% CI, 0.38-1.18), 1.51 (95% CI, 0.98-2.31), and 3.20 (95% CI, 1.34-7.60) for people <35, 35-50, and >50 years old, respectively, and 2.30 (95% CI, 1.03-5.14) for people with a CD4 cell count of <50 cells/μL.CONCLUSIONS: Tuberculosis incidence decreased after cART initiation but not among people >50 years old or with CD4 cell counts of <50 cells/μL. Despite an overall decrease in tuberculosis incidence, the increased rate during 3 months of ART suggests unmasking IRIS.

AB - BACKGROUND: The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries.METHODS: The HIV-CAUSAL Collaboration consisted of 12 cohorts from the United States and Europe of HIV-positive, ART-naive, AIDS-free individuals aged ≥18 years with baseline CD4 cell count and HIV RNA levels followed up from 1996 through 2007. We estimated hazard ratios (HRs) for cART versus no cART, adjusted for time-varying CD4 cell count and HIV RNA level via inverse probability weighting.RESULTS: Of 65 121 individuals, 712 developed tuberculosis over 28 months of median follow-up (incidence, 3.0 cases per 1000 person-years). The HR for tuberculosis for cART versus no cART was 0.56 (95% confidence interval [CI], 0.44-0.72) overall, 1.04 (95% CI, 0.64-1.68) for individuals aged >50 years, and 1.46 (95% CI, 0.70-3.04) for people with a CD4 cell count of <50 cells/μL. Compared with people who had not started cART, HRs differed by time since cART initiation: 1.36 (95% CI, 0.98-1.89) for initiation <3 months ago and 0.44 (95% CI, 0.34-0.58) for initiation ≥3 months ago. Compared with people who had not initiated cART, HRs <3 months after cART initiation were 0.67 (95% CI, 0.38-1.18), 1.51 (95% CI, 0.98-2.31), and 3.20 (95% CI, 1.34-7.60) for people <35, 35-50, and >50 years old, respectively, and 2.30 (95% CI, 1.03-5.14) for people with a CD4 cell count of <50 cells/μL.CONCLUSIONS: Tuberculosis incidence decreased after cART initiation but not among people >50 years old or with CD4 cell counts of <50 cells/μL. Despite an overall decrease in tuberculosis incidence, the increased rate during 3 months of ART suggests unmasking IRIS.

KW - AIDS-Related Opportunistic Infections

KW - Adult

KW - Anti-HIV Agents

KW - CD4 Lymphocyte Count

KW - Cohort Studies

KW - Developed Countries

KW - Drug Therapy, Combination

KW - Europe

KW - Female

KW - HIV Infections

KW - HIV Seropositivity

KW - Humans

KW - Immune Reconstitution Inflammatory Syndrome

KW - Incidence

KW - Male

KW - Middle Aged

KW - Mycobacterium tuberculosis

KW - Pneumocystis jirovecii

KW - Pneumonia, Pneumocystis

KW - RNA, Viral

KW - Tuberculosis

KW - United States

KW - Viral Load

U2 - 10.1093/cid/cis203

DO - 10.1093/cid/cis203

M3 - Article (Academic Journal)

C2 - 22460971

VL - 54

SP - 1364

EP - 1372

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 9

ER -

Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries

Abstract

Keywords

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ART-CC: Prognosis of HIV-infected patients treated with ART

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