van Halsema, CL;
Okhai, H;
Hill, T;
Sabin, CA;
UK Collaborative HIV Cohort (UK CHIC) Study, .;
(2020)
Incidence and risk factors for tuberculosis among people with HIV on antiretroviral therapy in the UK.
AIDS
, 34
(12)
pp. 1813-1821.
10.1097/QAD.0000000000002599.
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Abstract
OBJECTIVE: The UK has a low tuberculosis incidence and earlier combination antiretroviral therapy (cART) is expected to have reduced incidence among people with HIV. Epidemiological patterns and risk factors for active tuberculosis were analysed over a 20 year period among people accessing HIV care at sites participating in the UK CHIC observational study. DESIGN: Cohort analysis. METHODS: Data were included for individuals over 15 years old attending for HIV care between 1996 and 2017 inclusive, with at least three months follow up recorded. Incidence rates of new tuberculosis events were calculated and stratified by ethnicity (white/black/other) as a proxy for tuberculosis exposure. Poisson regression models were used to determine the associations of calendar year, ethnicity and other potential risk factors after cART initiation. RESULTS: 58,776 participants (26.3% female; 54.5% white, 32.0% black, 13.5% other/unknown ethnicity; median (interquartile range) age 34 (29-42) years) were followed for 546,617 person-years. 704 were treated for active tuberculosis (rate 1.3 [95% confidence interval (CI) 1.2-1.4]/1000 person-years). Tuberculosis incidence decreased from 1.3 [1.2-1.5] to 0.6 [0.4-0.9]/1000 person-years from pre-2004 to 2011-2017. The decline among people of black ethnicity was less steep than among those of white/other ethnicities, with incidence remaining high among black participants in the latest period (2.1 [1.4-3.1]/1000 person-years). 283 participants (191 (67%) black African) had tuberculosis with viral load < 50 copies/ml. CONCLUSIONS: Despite the known protective effect of cART against tuberculosis, a continuing disproportionately high incidence is seen among black African people. Results support further interventions to prevent tuberculosis in this group.
| Type: | Article |
|---|---|
| Title: | Incidence and risk factors for tuberculosis among people with HIV on antiretroviral therapy in the UK |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/QAD.0000000000002599 |
| Publisher version: | https://doi.org/10.1097/QAD.0000000000002599 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10100750 |
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