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The contribution of late HIV diagnosis on the occurrence of HIV-associated tuberculosis: a 5-year estimate using real-world data

Girardi, Enrico; Caro-Vega, Yanink; Cozzi-Lepri, Alessandro; Musaazi, Joseph; Carriquiry, Gabriela; Castelnuovo, Barbara; Gori, Andrea; ... Mussini, Cristina; + view all (2022) The contribution of late HIV diagnosis on the occurrence of HIV-associated tuberculosis: a 5-year estimate using real-world data. AIDS , 36 (14) pp. 2005-2013. 10.1097/QAD.0000000000003321. Green open access

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Abstract

OBJECTIVES: To describe the timing of tuberculosis (TB) presentation in relation to diagnosis of HIV infection and antiretroviral therapy (ART) initiation and to evaluate whether the established impact from late presentation to care and late initiation of ART on the risk of TB is retained beyond the observation period of clinical trials. DESIGN: We used marginal structural models to emulate a clinical trial with up to 5 years of follow-up to evaluate the impact of late initiation on TB risk. METHODS: People with HIV (PWH) were enrolled from 2007 to 2016 in observational cohorts from Uganda, Peru, Mexico and Italy. The risk of TB was compared in LP (accessing care with CD4+ ≤350 cells/μl) vs. nonlate presentation using survival curves and a weighted Cox regression. We emulated two strategies: initiating ART with CD4+ count less than 350 cells/μl vs. CD4+ count at least 350 cells/μl (late initiation). We estimated TB attributable risk and population attributable fraction up to 5 years from the emulated date of randomization. RESULTS: Twenty thousand one hundred and twelve patients and 1936 TB cases were recorded. Over 50% of TB cases were diagnosed at presentation for HIV care. More than 50% of the incident cases of TB after ART initiation were attributable to late presentation; nearly 70% of TB cases during the first year of follow-up could be attributed to late presentation and more than 50%, 5 years after first attending HIV care. CONCLUSION: Late presentation accounted for a large share of TB cases. Delaying ART initiation was detrimental for incident TB rates, and the impact of late presentation persisted up to 5 years from HIV care entry.

Type: Article
Title: The contribution of late HIV diagnosis on the occurrence of HIV-associated tuberculosis: a 5-year estimate using real-world data
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000003321
Publisher version: https://doi.org/10.1097/QAD.0000000000003321
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 > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
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
URI: https://discovery.ucl.ac.uk/id/eprint/10152396
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