Impact of Antiretroviral Therapy on Tuberculosis Incidence Among HIV-Positive Patients in High-Income Countries

作者：del Amo Julia^*; Moreno Santiago; Bucher Heiner C; Furrer Hansjakob; Logan Roger; Sterne Jonathan; Perez Hoyos Santiago; Jarrin Inma; Phillips Andrew; Lodi Sara; van Sighem Ard; de Wolf Frank; Sabin Caroline; Bansi Loveleen; Justice Amy; Goulet Joseph; Miro Jose M; Ferrer Elena; Meyer Laurence; Seng Remonie; Toulomi Giota; Gargalianos Panagiotis; Costagliola Dominique; Abgrall Sophie; Hernan Miguel A

来源：Clinical Infectious Diseases, 2012, 54(9): 1364-1372.

DOI：10.1093/cid/cis203

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. %26lt;br%26gt;Methods. The HIV-CAUSAL Collaboration consisted of 12 cohorts from the United States and Europe of HIV-positive, ART-naive, AIDS-free individuals aged %26gt;= 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. %26lt;br%26gt;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 %26gt; 50 years, and 1.46 (95% CI, 0.70-3.04) for people with a CD4 cell count of %26lt; 50 cells/mu L. 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 %26lt; 3 months ago and 0.44 (95% CI, 0.34-0.58) for initiation %26gt;= 3 months ago. Compared with people who had not initiated cART, HRs %26lt; 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 %26lt; 35, 35-50, and %26gt; 50 years old, respectively, and 2.30 (95% CI, 1.03-5.14) for people with a CD4 cell count of %26lt; 50 cells/mu L. %26lt;br%26gt;Conclusions. Tuberculosis incidence decreased after cART initiation but not among people %26gt; 50 years old or with CD4 cell counts of %26lt; 50 cells/mu L. Despite an overall decrease in tuberculosis incidence, the increased rate during 3 months of ART suggests unmasking IRIS.

• 出版日期2012-5-1