Tuberculosis among HIV-positive patients across Europe: changes over time and risk factors

TY - JOUR

T1 - Tuberculosis among HIV-positive patients across Europe: changes over time and risk factors

AU - Kruk, Alexey

AU - Bannister, Wendy

AU - Podlekareva, Daria N

AU - Chentsova, Nelly P

AU - Rakhmanova, Aza G

AU - Horban, Andrzej

AU - Domingo, Perre

AU - Mocroft, Amanda

AU - Lundgren, Jens D

AU - Kirk, Ole

AU - on behalf of the EuroSIDA study group

PY - 2011/7/31

Y1 - 2011/7/31

N2 - Objective: To describe temporal changes in the incidence rate of tuberculosis (TB) (pulmonary or extrapulmonary) among HIV-positive patients in western Europe and risk factors of TB across Europe. Methods: Poisson regression models were used to determine temporal changes in incidence rate of TB among 11952 patients from western Europe (1994-2010), and to assess risk factors for TB among 12673 patients from across Europe with follow-up after 2001. Results: Two hundred and seventy-seven TB events occurred during 84221 person-years of follow-up (PYFU) in western Europe. The incidence rate declined from 1.91 [95% confidence interval (CI) 1.51-2.37)] in 1994-1995 to 0.12 (0.07-0.21)/100 PYFU in 2002-2003, and remained stable thereafter. After January 2001, 159 TB events were diagnosed; 65 cases in western Europe and 94 cases in eastern Europe; resulting in incidence rates of 0.12 (0.09-0.14) and 0.65 (0.52-0.79)/100 PYFU, respectively. In multivariable analysis, incidence rate of TB was approximately four-fold higher in eastern Europe compared with western Europe [incidence rate ratio (IRR) 4.25 (2.78-6.49), P<0.001]. There were no significant temporal changes after 2001 and risk factors did not differ significantly between eastern Europe and western Europe. Lower CD4 + cell counts, higher HIV-RNA levels, male sex, intravenous drug usage and African origin were all associated with higher risk of TB. Conclusion: Incidence rates of TB in western Europe remained at a very low and stable level since 2001. After 2001, patients in eastern Europe were at substantially higher risk of TB than in western Europe. TB is of great concern in HIV-positive patients, especially in areas with high TB prevalence, high levels of immigration from TB-endemic regions, and with suboptimal access to combination antiretroviral therapy.

AB - Objective: To describe temporal changes in the incidence rate of tuberculosis (TB) (pulmonary or extrapulmonary) among HIV-positive patients in western Europe and risk factors of TB across Europe. Methods: Poisson regression models were used to determine temporal changes in incidence rate of TB among 11952 patients from western Europe (1994-2010), and to assess risk factors for TB among 12673 patients from across Europe with follow-up after 2001. Results: Two hundred and seventy-seven TB events occurred during 84221 person-years of follow-up (PYFU) in western Europe. The incidence rate declined from 1.91 [95% confidence interval (CI) 1.51-2.37)] in 1994-1995 to 0.12 (0.07-0.21)/100 PYFU in 2002-2003, and remained stable thereafter. After January 2001, 159 TB events were diagnosed; 65 cases in western Europe and 94 cases in eastern Europe; resulting in incidence rates of 0.12 (0.09-0.14) and 0.65 (0.52-0.79)/100 PYFU, respectively. In multivariable analysis, incidence rate of TB was approximately four-fold higher in eastern Europe compared with western Europe [incidence rate ratio (IRR) 4.25 (2.78-6.49), P<0.001]. There were no significant temporal changes after 2001 and risk factors did not differ significantly between eastern Europe and western Europe. Lower CD4 + cell counts, higher HIV-RNA levels, male sex, intravenous drug usage and African origin were all associated with higher risk of TB. Conclusion: Incidence rates of TB in western Europe remained at a very low and stable level since 2001. After 2001, patients in eastern Europe were at substantially higher risk of TB than in western Europe. TB is of great concern in HIV-positive patients, especially in areas with high TB prevalence, high levels of immigration from TB-endemic regions, and with suboptimal access to combination antiretroviral therapy.

U2 - 10.1097/QAD.0b013e328348fafd

DO - 10.1097/QAD.0b013e328348fafd

M3 - Journal article

C2 - 21610489

SN - 1350-2840

VL - 25

SP - 1505

EP - 1513

JO - AIDS, Supplement

JF - AIDS, Supplement

IS - 12

ER -