Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India
Abstract 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 di...
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doaj-5ca1f611bac744f48892cee6081f2a502020-11-25T04:00:00ZengBMCBMC Infectious Diseases1471-23342019-10-011911910.1186/s12879-019-4569-zIncidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in IndiaAkshay N. Gupte0Dileep Kadam1Shashikala Sangle2Bharat B. Rewari3Sonali Salvi4Amol Chavan5Smita Nimkar6Jonathan Golub7Nikhil Gupte8Amita Gupta9Ivan Marbaniang10Vidya Mave11Johns Hopkins University School of MedicineByramjee-Jeejeebhoy Medical CollegeByramjee-Jeejeebhoy Medical CollegeFormer National Programme Office, National AIDS Control OrganizationByramjee-Jeejeebhoy Medical College Clinical Trials UnitByramjee-Jeejeebhoy Medical College Clinical Trials UnitByramjee-Jeejeebhoy Medical College Clinical Trials UnitJohns Hopkins University School of MedicineJohns Hopkins University School of MedicineJohns Hopkins University School of MedicineByramjee-Jeejeebhoy Medical College Clinical Trials UnitJohns Hopkins University School of MedicineAbstract 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.http://link.springer.com/article/10.1186/s12879-019-4569-zHIVTuberculosisSecond-line ARTCompeting risksIndia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Akshay N. Gupte Dileep Kadam Shashikala Sangle Bharat B. Rewari Sonali Salvi Amol Chavan Smita Nimkar Jonathan Golub Nikhil Gupte Amita Gupta Ivan Marbaniang Vidya Mave |
spellingShingle |
Akshay N. Gupte Dileep Kadam Shashikala Sangle Bharat B. Rewari Sonali Salvi Amol Chavan Smita Nimkar Jonathan Golub Nikhil Gupte Amita Gupta Ivan Marbaniang Vidya Mave Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India BMC Infectious Diseases HIV Tuberculosis Second-line ART Competing risks India |
author_facet |
Akshay N. Gupte Dileep Kadam Shashikala Sangle Bharat B. Rewari Sonali Salvi Amol Chavan Smita Nimkar Jonathan Golub Nikhil Gupte Amita Gupta Ivan Marbaniang Vidya Mave |
author_sort |
Akshay N. Gupte |
title |
Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India |
title_short |
Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India |
title_full |
Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India |
title_fullStr |
Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India |
title_full_unstemmed |
Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India |
title_sort |
incidence of tuberculosis in hiv-infected adults on first- and second-line antiretroviral therapy in india |
publisher |
BMC |
series |
BMC Infectious Diseases |
issn |
1471-2334 |
publishDate |
2019-10-01 |
description |
Abstract 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. |
topic |
HIV Tuberculosis Second-line ART Competing risks India |
url |
http://link.springer.com/article/10.1186/s12879-019-4569-z |
work_keys_str_mv |
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