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HIV replication and tuberculosis risk among people living with HIV in Europe: A multicohort analysis, 1983-2015
A. Atkinson, D. Kraus, N. Banholzer, JM. Miro, P. Reiss, O. Kirk, C. Mussini, P. Morlat, D. Podlekareva, AD. Grant, C. Sabin, M. van der Valk, V. Le Moing, L. Meyer, R. Seng, A. Castagna, N. Obel, A. Antoniadou, D. Salmon, M. Zwahlen, M. Egger,...
Language English Country United States
Document type Journal Article
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- MeSH
- Adult MeSH
- HIV Infections * epidemiology immunology complications MeSH
- Incidence MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- CD4 Lymphocyte Count MeSH
- Virus Replication MeSH
- Risk Factors MeSH
- RNA, Viral MeSH
- Tuberculosis * epidemiology immunology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
INTRODUCTION: HIV replication leads to a change in lymphocyte phenotypes that impairs immune protection against opportunistic infections. We examined current HIV replication as an independent risk factor for tuberculosis (TB). METHODS: We included people living with HIV from 25 European cohorts 1983-2015. Individuals <16 years or with previous TB were excluded. Person-time was calculated from enrolment (baseline) to the date of TB diagnosis or last follow-up information. We used adjusted Poisson regression and general additive regression models. RESULTS: We included 272,548 people with a median follow-up of 5.9 years (interquartile range [IQR] 2.3-10.9). At baseline, the median CD4 cell count was 355 cells/μL (IQR 193-540) and the median HIV-RNA level 22,000 copies/mL (IQR 1,300-103,000). During 1,923,441 person-years of follow-up, 5,956 (2.2%) people developed TB. Overall, TB incidence was 3.1 per 1,000 person-years (95% confidence interval [CI] 3.02-3.18) and was four times higher in patients with HIV-RNA levels of 10,000 compared with levels <400 copies/mL in any CD4 stratum. CD4 and HIV-RNA time-updated analyses showed that the association between HIV-RNA and TB incidence was independent of CD4. The TB incidence rate ratio for people born in TB-endemic countries compared with those born in Europe was 1.8 (95% CI 1.5-2.2). CONCLUSIONS: Our results indicate that ongoing HIV replication (suboptimal HIV control) is an important risk factor for TB, independent of CD4 count. Those at highest risk of TB are people from TB-endemic countries. Close monitoring and TB preventive therapy for people with suboptimal HIV control is important.
CHU de Montpellier Université de Montpellier Montpellier France
CIBERINFEC Instituto de Salud Carlos 3 Madrid Spain
Clinic of Infectious Diseases University of Modena and Reggio Emilia Modena Italy
Department of Clinical Research London School of Hygiene and Tropical Medicine London United Kingdom
Department of Infectious Diseases Bern University Hospital University of Bern Bern Switzerland
Department of Infectious Diseases Institut Fournier Paris France
Department of Infectious Diseases IRCCS San Raffaele Scientific Institute Milan Italy
Department of Infectious Diseases Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
Department of Mathematics and Statistics Masaryk University Brno Czech Republic
Department of Respiratory and Infectious Diseases Copenhagen University Hospital Bispebjerg Denmark
Infectious Diseases Service Hospital Clinic IDIBAPS University of Barcelona Barcelona Spain
Institute for Global Health University College London London United Kingdom
Institute of Social and Preventive Medicine University of Bern Bern Switzerland
Population Health Sciences Bristol Medical School University of Bristol Bristol United Kingdom
References provided by Crossref.org
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