Winter, JR;
Stagg, HR;
Smith, CJ;
Brown, AE;
Lalor, MK;
Lipman, M;
Pozniak, A;
... Abubakar, I; + view all
(2017)
Injecting drug use predicts active tuberculosis in a national cohort of people living with HIV from 2000 to 2014.
AIDS
, 31
(17)
pp. 2403-2413.
10.1097/QAD.0000000000001635.
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Abstract
OBJECTIVES: Tuberculosis (TB) is common in people living with HIV (PLHIV), leading to worse clinical outcomes including increased mortality. We investigated risk factors for developing TB following HIV diagnosis. DESIGN: Adults aged ≥15 years first presenting to health services for HIV care in England, Wales or Northern Ireland from 2000-2014 were identified from national HIV surveillance data and linked to TB surveillance data. METHODS: We calculated incidence rates for TB occurring >91 days after HIV diagnosis and investigated risk factors using multivariable Poisson regression. RESULTS: 95,003 adults diagnosed with HIV were followed for 635,591 person-years (PY); overall incidence of TB was 344/100,000PY (95% confidence interval 330-359). TB incidence was high for people who acquired HIV through injecting drugs (PWID; men 876 [696-1,104], women 605 [528-593]) and black Africans born in high TB incidence countries (644 [612-677]). The adjusted incidence rate ratio (IRR) for TB amongst PWID was 4.79 [3.35-6.85] for men and 6.18 [3.49-10.93] for women, compared to men who have sex with men. The adjusted IRR for TB in black Africans from high-TB countries was 4 27 (3 42-5 33), compared to white UK-born individuals. Lower time-updated CD4 count was associated with increased rates of TB. CONCLUSIONS: PWID had the greatest risk of TB; incidence rates were comparable to those in black Africans from high TB incidence countries. Most TB cases in PWID were UK-born, and likely acquired TB through transmission within the UK. Earlier HIV diagnosis and quicker initiation of ART should reduce TB incidence in these populations.
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