Tuberculosis incidence in country of origin is a key determinant of the risk of active tuberculosis in people living with HIV: Data from a 30‐year observational cohort study

Abstract

Introduction People living with HIV (PLWH) are at high risk of active tuberculosis (TB) but this risk in the era of antiretroviral treatment (ART) remains unclear. It is critical to identify the groups who should be prioritised for latent TB (LTBI) screening. In this study we identified the risk factors associated with developing incident TB disease, by analysing a 30‐year observational cohort. Methods We evaluated PLWH in Leicester, UK, between 1983 and 2017 to ascertain those who developed active TB and the timing of this in relation to HIV diagnosis; whether before, concurrently with, or more than 3 months after the diagnosis of HIV (incident TB). Predictors of incident TB were ascertained using Cox proportional hazards models. Results In all, 325 out of 2158 (15.1%) PLWH under care had had active TB; 64/325 (19.7%) prior to HIV diagnosis, 161/325 (49.5%) concurrently with/within 3 months of HIV diagnosis and 100/325 (30.8%) had incident TB. Incident TB risk was 4.57/1000 person‐years. Increased TB incidence in the country of birth was associated with an increased risk of developing incident TB [50–149/100 000 population, adjusted hazard ratio (AHR) = 3.10, 95% CI: 0.94–10.20; 150–249/100 000 population, AHR = 7.14, 95% CI: 3.46–14.74; 250–349/100 000 population, AHR = 5.90, 95% CI: 2.32–14.99; ≥ 350/100 000 population, AHR = 3.96, 95% CI: 1.39–11.26]. Conclusions Tuberculosis risk remains high among PLWH and is related to TB incidence in the country of birth. Further work is required to determine whether specific groups of PLWH should be targeted for programmatic LTBI screening, and whether it will result in high uptake and completion of chemoprophylaxis and is cost‐effective for widespread implementation.

Assessing the spatial heterogeneity of tuberculosis in a population with internal migration in China: a retrospective population-based study

“…Internal migrant TB cases in Shanghai might have been infected with Mycobacterium tuberculosis before coming to Shanghai and then developed symptoms in Shanghai. Like the epidemiology of TB among international immigrants, the internal migrant TB in our study also showed a significant correlation with the background notified incidence of TB in their places of origin ( 28 , 29 ). Therefore, the TB background characteristics in the original residential area of migrants might be one of the drivers of TB burden in their destinated cities.…”

The impact, effectiveness and outcomes of targeted screening thresholds for programmatic latent tuberculosis infection testing in HIV

“…Overall, 11.1% (117/1053) of screened patients had LTBI, confirming that there is significant potential to reduce incident TB rates amongst PWH in the UK. TB incidence in this Leicester cohort is extremely high: of the 2158 patients ever treated for HIV in Leicester, 325 (15%) have had active TB, with 100 of these (31%) having incident TB occurring more than 3 months after HIV diagnosis [15,27]. Therefore, it is imperative that the burden of LTBI amongst PWH is addressed to prevent incidence of active infection.…”

Advances in Antiretroviral Therapy for Patients with Human Immunodeficiency Virus-Associated Tuberculosis

“…In contrast, preventive treatment of tuberculosis is a protective factor against incident tuberculosis [ 17 ]. Another study from the UK also showed that having a country of birth with a high tuberculosis burden was a significant risk factor for developing active HIV-related tuberculosis [ 18 ]. A meta-analysis among PLWH in Sub-Saharan Africa revealed that being underweight, having a low CD4 count, male gender, advanced WHO clinical stages, anemia, bedridden/ambulatory functional status, lack of isoniazid preventive therapy and lack of cotrimoxazole could boost the risk of tuberculosis occurrence [ 19 ].…”