Incidence and risk factors for tuberculosis in people living with HIV: cohort from HIV referral health centers in Recife, Brazil

PLoS One. 2013 May 10;8(5):e63916. doi: 10.1371/journal.pone.0063916. Print 2013.

Abstract

Objective: To identify the incidence of and risk factors for tuberculosis in people living with HIV (PLHIV).

Design: Observational, prospective cohort study.

Methods: A total of 2069 HIV-infected patients was observed between July 2007 and December 2010. The Kaplan-Meier method was used to estimate the probability of survival free of tuberculosis, and Cox regression analysis to identify risk factors associated with the development of tuberculosis.

Results: Survival free of tuberculosis (TB) was 91%. The incidence rate of tuberculosis was 2.8 per 100 persons/years. Incidence of tuberculosis was higher when subjects had CD4 cell count <200 cells/mm(3); were not on antiretroviral therapy; in those who had, a body mass index <18.5 kg/m(2), anemia (or were not tested for it), were illiterate or referred previous tuberculosis treatment at entry into the cohort. Those not treated for latent TB infection had a much higher risk (HR = 7.9) of tuberculosis than those with a negative tuberculin skin test (TST). Having a TST≥5 mm but not being treated for latent TB infection increased the risk of incident tuberculosis even in those with a history of previous tuberculosis.

Conclusions: Preventive actions to reduce the risk of TB in people living with HIV should include an appropriate HAART and treatment for latent TB infection in those with TST≥5 mm. The actions towards enabling rigorous implementation of treatment of latent TB infection and targeting of PLHIV drug users both at the individual and in public health level can reduce substantially the incidence of TB in PLHIV.

MeSH terms

  • Adolescent
  • Adult
  • Brazil / epidemiology
  • Cohort Studies
  • Coinfection / epidemiology*
  • Female
  • HIV Infections / epidemiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Risk Factors
  • Tuberculosis / epidemiology*
  • Tuberculosis / mortality
  • Young Adult

Grant support

This study received support from the Ministério da Saúde/Programa DST/AIDS/UNESCO (CSV 182/06 - Projeto “Estudo Clínico-Epidemiológico da Co-Infecção HIV/Tuberculose em Recife”). The authors received partial support from the Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq (scholarship 150425/2012-0 to J.D.L.B., 301779/2009-0 to M.F.P.M. and 300917/2006-6 to R.A.A.X.).