Incidence of active tuberculosis among people living with HIV receiving long‐term antiretroviral therapy in high TB/HIV burden settings in Thailand: implication for tuberculosis preventive therapy

作者：Gompol Suwanpimolkul, Sivaporn Gatechompol, Kamon Kawkitinarong, Thornthun Ueaphongsukkit, Jiratchaya Sophonphan, Nirada Siriyakorn, Supunnee Jirajariyavej, Suwimon Khusuwan, Palakorn Panarat, Surat Wannalerdsakun, Natcha Saetiew, Sunee Chayangsu, Sirichai Wiwatrojanagul, Preudtipong Noopetch, Praniti Danpornprasert, Sripetcharat Mekviwattanawong, Chris Fujitnirun, Cheewanan Lertpiriyasuwat, Win Min Han, Stephen J. Kerr, Kiat Ruxrungtham, Anchalee Avihingsanon, and the HIV‐TB study team · 发表于：Journal of the International AIDS Society · 年份：2022 · DOI：10.1002/jia2.25900 · 被引用次数：20 · 研究领域：Tuberculosis Research and Epidemiology、HIV/AIDS Research and Interventions、Pneumocystis jirovecii pneumonia detection and treatment

Abstract Introduction Among high tuberculosis (TB) and HIV burden countries in Asia, tuberculosis preventive therapy (TPT) in people living with HIV (PLWH) has been underutilized despite its proven benefits independent of antiretroviral therapy (ART). Therefore, we determined the incidence of active TB and mortality among 9179 adult PLWH who attended and received ART from 15 tertiary care hospitals across Thailand. Methods A retrospective study was conducted in 2018 using follow‐up data from 1999 to 2018. The primary endpoint was incident TB disease after ART initiation. Factors associated with TB incidence were analysed using competing risk regression. The Kaplan–Meier method was used to estimate mortality after ART initiation. Results During a median of 5.1 years of ART (IQR 2.2–9.5 years), 442 (4.8%) PLWH developed TB (TB/HIV), giving an overall incidence of 750 (95% CI 683–823) per 100,000 persons‐year of follow up (PYFU). In multivariate analysis, lower CD4 at ART initiation (≤100 cells/mm 3 , adjusted sub‐distribution hazard ratio [aSHR]: 2.08, 95% CI, 1.47–2.92; 101–200 cells/mm 3 , aSHR: 2.21, 95% CI, 1.54–3.16; 201–350 cells/mm 3 , aSHR: 1.59, 95% CI, 1.11–2.28 vs. >350 cells/mm 3 ), male sex (aSHR: 1.40, 95% CI, 1.11–1.78), lower body weight (<50 kg, aSHR: 1.52, 95% CI, 1.17–1.95) and prior TB event (aSHR: 3.50, 95% CI, 2.72–4.52) were associated with TB incidence. PLWH with HIV RNA ≥50 copies/ml had 5–9 times higher risk of active TB disease higher than those...