Tuberculosis among people with HIV infection in the United Kingdom: opportunities for prevention?

Grant, AD; Bansi, L; Ainsworth, J; Anderson, J; Delpech, V; Easterbrook, P; Fisher, M; Gazzard, B; Gilson, R; Gompels, M; Hill, T; Johnson, M; Leen, C; Orkin, C; Phillips, AN; Porter, K; Post, F; Walsh, J; Sabin, CA; United Kingdom Collaborative HIV Cohort Study Group, ; (2009) Tuberculosis among people with HIV infection in the United Kingdom: opportunities for prevention? AIDS (London, England), 23 (18). pp. 2507-15. ISSN 0269-9370 DOI:

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OBJECTIVE: To investigate the incidence of, and risk factors for, tuberculosis among HIV clinic attendees in the United Kingdom. DESIGN AND METHODS: Observational cohort study of 27 868 individuals in the United Kingdom Collaborative HIV Cohort collaboration, 1996-2005. RESULTS: Among individuals not taking combination antiretroviral therapy (cART), tuberculosis incidence was considerably higher among individuals of black African vs. white or other ethnicities {incidence rates 9.9 [95% confidence intervals (CIs) 7.2, 12.6], 2.5 [95% CI 1.8, 3.0] and 4.4 [95% CI 2.7, 6.0] episodes per 1000 person-years, respectively}. Tuberculosis incidence decreased with time after starting cART; among black Africans, incidence was consistently higher and remained substantial (5.3 per 1000 person-years) at 24 months and longer after starting cART. The strongest independent risk factors for tuberculosis after cART start were most recent CD4 cell count: adjusted rate ratios (aRR) 10.65 (95% CI 6.11, 18.57), 3.40 (95% CI 2.05, 5.65), 1.77 (95% CI 1.06, 2.96) and 1.84 (95% CI 1.09, 3.12) for individuals with CD4 cell counts less than 50, 50-199, 200-349 and 350-499 cells/microl, respectively, compared with at least 500 cells/microl; and black African vs. white ethnicity [aRR 2.93 (95% CI 1.89, 4.54)]. HIV risk group, shorter time on cART, later calendar period and unsuppressed viral load were also independently associated with incident tuberculosis. CONCLUSIONS: Tuberculosis incidence among people attending UK HIV clinics is substantial, particularly among those with non-white ethnicity and low CD4 cell counts, even after starting cART. Earlier HIV diagnosis is needed in order to implement interventions to prevent tuberculosis; tuberculosis preventive therapy should be considered in addition to cART.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: TB Centre
PubMed ID: 19770622
Web of Science ID: 272135800015


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