TY - JOUR
T1 - Risk of tuberculosis after achieving HIV virological suppression on antiretroviral therapy
T2 - a Danish nationwide prospective cohort study
AU - Virdee, Amrit Kaur
AU - Knudtzen, Fredrikke Christie
AU - Llibre, Josep M
AU - Omland, Lars Haukali
AU - Obel, Niels
AU - Stærke, Nina Breinholt
AU - Åhsberg, Johanna
AU - Ørsted, Iben
AU - Kronborg, Gitte
AU - Mohey, Rajesh
AU - Montejo, Maria Del Pilar Fernandez
AU - Johansen, Isik Somuncu
AU - Martin-Iguacel, Raquel
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2025/4/30
Y1 - 2025/4/30
N2 - BACKGROUND: In countries with low tuberculosis burden, the risk of tuberculosis in people with human immunodeficiency virus (HIV; PWH) once HIV virological suppression is achieved is not fully understood.METHODS: In a nationwide cohort, we included all adult PWH from the Danish HIV Cohort initiating antiretroviral therapy (ART) (1995-2017) without prior tuberculosis disease. We used Kaplan-Meier estimation and Poisson regression to calculate the tuberculosis incidence rate (IR) after 6 months of ART, along with associated risk factors and mortality rates.RESULTS: Among 6849 PWH initiating ART (median follow-up, 7.4 years), 84 developed tuberculosis (IR, 1.4/1000 person-years [PY]), 54 of them >6 months after ART initiation (IR, 0.97/1000 PY [95% confidence interval [CI]: 1.17-1.79); 1.95/1000 PY [1.34-2.76] in non-Danish born, 0.36/1000 PY [.21-.62] in Danish born without injection drug use (IDU), and 2.95/1000 PY [1.53-5.66] in Danish born with IDU). Danish-born individuals with suppressed viremia and no IDU or known tuberculosis exposures had the lowest risk (IR, 0.05/1000 PY). In the adjusted analysis, being non-Danish born (adjusted IR ratio, 4.27 [95% CI: 2.36-7.72]), IDU (4.95 [2.55-9.62]), and previous AIDS-defining events (2.05 [1.06-3.94]) raised the tuberculosis risk, while suppressed HIV RNA levels (0.58 [.34-.99]) reduced it. The overall mortality rate for HIV/tuberculosis coinfected after ART was high, at 48.9/1000 PY (95% CI: 30.4-78.7).CONCLUSIONS: The tuberculosis risk remains elevated in PWH beyond 6 months after ART initiation, especially among migrants, those with IDU, those without suppressed HIV RNA, and those exposed to areas highly endemic for tuberculosis or with social risk determinants of health. Conversely, PWH without these risk factors have a tuberculosis risk similar to the general population and would not require targeted tuberculosis screening strategies.
AB - BACKGROUND: In countries with low tuberculosis burden, the risk of tuberculosis in people with human immunodeficiency virus (HIV; PWH) once HIV virological suppression is achieved is not fully understood.METHODS: In a nationwide cohort, we included all adult PWH from the Danish HIV Cohort initiating antiretroviral therapy (ART) (1995-2017) without prior tuberculosis disease. We used Kaplan-Meier estimation and Poisson regression to calculate the tuberculosis incidence rate (IR) after 6 months of ART, along with associated risk factors and mortality rates.RESULTS: Among 6849 PWH initiating ART (median follow-up, 7.4 years), 84 developed tuberculosis (IR, 1.4/1000 person-years [PY]), 54 of them >6 months after ART initiation (IR, 0.97/1000 PY [95% confidence interval [CI]: 1.17-1.79); 1.95/1000 PY [1.34-2.76] in non-Danish born, 0.36/1000 PY [.21-.62] in Danish born without injection drug use (IDU), and 2.95/1000 PY [1.53-5.66] in Danish born with IDU). Danish-born individuals with suppressed viremia and no IDU or known tuberculosis exposures had the lowest risk (IR, 0.05/1000 PY). In the adjusted analysis, being non-Danish born (adjusted IR ratio, 4.27 [95% CI: 2.36-7.72]), IDU (4.95 [2.55-9.62]), and previous AIDS-defining events (2.05 [1.06-3.94]) raised the tuberculosis risk, while suppressed HIV RNA levels (0.58 [.34-.99]) reduced it. The overall mortality rate for HIV/tuberculosis coinfected after ART was high, at 48.9/1000 PY (95% CI: 30.4-78.7).CONCLUSIONS: The tuberculosis risk remains elevated in PWH beyond 6 months after ART initiation, especially among migrants, those with IDU, those without suppressed HIV RNA, and those exposed to areas highly endemic for tuberculosis or with social risk determinants of health. Conversely, PWH without these risk factors have a tuberculosis risk similar to the general population and would not require targeted tuberculosis screening strategies.
KW - Adult
KW - Anti-HIV Agents/therapeutic use
KW - Denmark/epidemiology
KW - Female
KW - HIV Infections/drug therapy
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Risk Factors
KW - Tuberculosis/epidemiology
KW - Viral Load/drug effects
KW - risk factors
KW - antiretroviral therapy (ART)
KW - Tuberculosis
KW - HIV/tuberculosis coinfection
KW - HIV viral suppression
UR - http://www.scopus.com/inward/record.url?scp=105003956119&partnerID=8YFLogxK
U2 - 10.1093/cid/ciae499
DO - 10.1093/cid/ciae499
M3 - Journal article
C2 - 39378332
SN - 1058-4838
VL - 80
SP - 854
EP - 863
JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
IS - 4
ER -