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Tuberculosis among people with HIV infection in the United Kingdom: opportunities for prevention? United Kingdom Collaborative HIV Cohort Study Group

Grant, AD; Bansi, L; Ainsworth, J; Anderson, J; Delpech, V; Easterbrook, P; Fisher, M; ... United Kingdom Collaborative HIV C, ; + view all (2009) Tuberculosis among people with HIV infection in the United Kingdom: opportunities for prevention? United Kingdom Collaborative HIV Cohort Study Group. AIDS , 23 (18) 2507 - 2515. 10.1097/QAD.0b013e3283320dfd.

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Abstract

Objective: To investigate the incidence of, and risk factors for, tuberculosis among HIV clinic attendees in the United Kingdom.Design and methods: Observational cohort study of 27 868 individuals in the United Kingdom Collaborative HIV Cohort collaboration, 1996-2005.Results: Among individuals not taking combination antiretroviral therapy (cART), tuberculosis incidence was considerably higher among individuals of black African vs. white or other ethnicities {incidence rates 9.9 [95% confidence intervals (CIs) 7.2, 12.6], 2.5 [95% CI 1.8, 3.0] and 4.4 [95% CI 2.7, 6.0] episodes per 1000 person-years, respectively}. Tuberculosis incidence decreased with time after starting cART; among black Africans, incidence was consistently higher and remained substantial (5.3 per 1000 person-years) at 24 months and longer after starting cART. The strongest independent risk factors for tuberculosis after cART start were most recent CD4 cell count: adjusted rate ratios (aRR) 10.65 (95% CI 6.11, 18.57), 3.40 (95% CI 2.05, 5.65), 1.77 (95% Cl 1.06, 2.96) and 1.84 (950% Cl 1.09, 3.12) for individuals with CD4 cell counts less than 50, 50-199, 200-349 and 350-499 cells/mu l, respectively, compared with at least 500 cells/mu l; and black African vs. white ethnicity [aRR 2.93 (95% Cl 1.89, 4.54)]. HIV risk group, shorter time on cART, later calendar period and unsuppressed viral load were also independently associated with incident tuberculosis.Conclusions: Tuberculosis incidence among people attending UK HIV clinics is substantial, particularly among those with non-white ethnicity and low CD4 cell counts, even after starting cART. Earlier HIV diagnosis is needed in order to implement interventions to prevent tuberculosis; tuberculosis preventive therapy should be considered in addition to cART. (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Type: Article
Title: Tuberculosis among people with HIV infection in the United Kingdom: opportunities for prevention? United Kingdom Collaborative HIV Cohort Study Group
DOI: 10.1097/QAD.0b013e3283320dfd
Keywords: antiretroviral therapy, HIV infection, tuberculosis, United Kingdom, ACTIVE ANTIRETROVIRAL THERAPY, RISK-FACTORS, EPIDEMIOLOGY, MORTALITY, LONDON, IMPACT, HAART
UCL classification: UCL > Provost and Vice Provost Offices
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 Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/114192
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