Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India.

Citation: Gupte AN, Kadam D, Sangle S, Rewari BB, Salvi S, Chavan A, Nimkar S, Golub J, Gupte N, Gupta A, Marbaniang I, Mave V. Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India. BMC Infect Dis. 2019 Oct 29;19(1):914. doi: 10.1186/s12879-019-4569-z. PMID: 31664933; PMCID: PMC6820927.

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https://www.ncbi.nlm.nih.gov/pubmed/31664933

BACKGROUND:
Programmatic data on the baseline risk of tuberculosis in people living with HIV (PLHIV) are needed to evaluate long-term effectiveness of the ongoing isoniazid preventive therapy (IPT) roll-out in India.

METHODS:
We estimated the incidence rate and risk factors of tuberculosis disease in adult PLHIV initiating first- and second-line anti-retroviral therapy (ART) prior to widespread IPT in a public ART center in Pune, India.

RESULTS:
4067 participants contributing 5205.7 person-years of follow-up on first-line ART and 871 participants contributing 1031.7 person-years of follow-up on second-line ART were included in the analysis. The incidence rate of tuberculosis was 4.39 cases (95%CI 3.86-5.00) per 100 person-years on first-line ART and 1.64 cases (95%CI 1.01-2.63) per 100 person-years on second-line ART (p < 0.001). After adjusting for competing risks, male sex (aSHR = 1.33, 95%CI 1.02-1.74, p = 0.03), urban residence (aSHR = 1.53, 95%CI 1.13-2.07, p = 0.006) and CD4+ counts < 350 cells/mm3 (aSHR = 3.06 vs CD4 > 350 cells/mm3, 95%CI 1.58-5.94, p < 0.001) at ART initiation were associated with higher risk of tuberculosis independent of ART regimen.

CONCLUSION:
Risk of tuberculosis was lower in PLHIV receiving second-line ART compared to first-line ART. Prioritizing IPT in PLHIV with low CD4+ counts, urban residence and in males may further mitigate the risk of tuberculosis during ART.

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