High TB rates in South Africans starting ART regardless of CD4s
People starting antiretroviral therapy (ART) in rural KwaZulu-Natal, South Africa, had high tuberculosis rates regardless of their CD4 count. TB incidence waned after the first 3 months of ART but remained at a high level.
HIV infection and TB are both highly prevalent in many parts of sub-Saharan Africa. To get a better understanding of the precise TB burden in rural KwaZulu-Natal, CAPRISA AIDS Treatment Programme investigators performed this retrospective analysis of 969 consecutive adults who started ART between January 2007 and December 2010.
Among the 969 people enrolled, 173 (17.9%, 95% confidence interval [CI] 15.5 to 20.4) had active TB when they started ART. TB incidence (the new-diagnosis rate) was more than 3 times higher in the first 3 months of ART (11.5 per 100 person-years, 95% CI 7.1 to 17.5) than in treatment months 4 through 24 (3.2 per 100 person-years, 95% CI 2.2 to 4.5) (incidence rate ratio 3.6, 95% CI 2.0 to 6.4, P < 0.001).
CD4 count when ART began did not affect TB incidence, with rates of 5.3 per 100 person-years in those starting with under 50 cells/µL and 4.9 per 100 person-years in those starting with more than 200 cells/µL (P = 0.81).
The researchers conclude that “rural HIV treatment programmes in TB-endemic settings experience high rates of TB irrespective of immunologic status of patients at [ART] initiation, or duration on [ART].”
Source: Kogieleum Naidoo, Quarraisha Abdool Karim, Ambika Bhushan, Kasavan Naidoo, Nonhlanhla Yende-Zuma, Patricia K. Mchunu, Janet Frohlich, Farina Karim, Michele Upfold, Paul Kocheleff, Salim S. Abdool Karim. High rates of tuberculosis in patients accessing HAART in rural South Africa. JAIDS. 2014; 65: 438-446.
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