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HIV viral load as an independent risk factor for tuberculosis in South Africa: collaborative analysis of cohort studies

Fenner, Lukas and Atkinson, Andrew and Boulle, Andrew and Fox, Matthew P. and Prozesky, Hans and Zürcher, Kathrin and Ballif, Marie and Furrer, Hansjakob and Zwahlen, Marcel and Davies, Mary-Ann and Egger, Matthias and International Epidemiology Database to Evaluate Aids in Southern, . (2017) HIV viral load as an independent risk factor for tuberculosis in South Africa: collaborative analysis of cohort studies. Journal of the International AIDS Society, 20. p. 21327.

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Official URL: http://edoc.unibas.ch/55665/

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Abstract

Chronic immune activation due to ongoing HIV replication may lead to impaired immune responses against opportunistic infections such as tuberculosis (TB). We studied the role of HIV replication as a risk factor for incident TB after starting antiretroviral therapy (ART).; We included all HIV-positive adult patients (≥16 years) in care between 2000 and 2014 at three ART programmes in South Africa. Patients with previous TB were excluded. Missing CD4 cell counts and HIV-RNA viral loads at ART start (baseline) and during follow-up were imputed. We used parametric survival models to assess TB incidence (pulmonary and extrapulmonary) by CD4 cell and HIV-RNA levels, and estimated the rate ratios for TB by including age, sex, baseline viral loads, CD4 cell counts, and WHO clinical stage in the model. We also used Poisson general additive regression models with time-updated CD4 and HIV-RNA values, adjusting for age and sex.; We included 44,260 patients with a median follow-up time of 2.7 years (interquartile range [IQR] 1.0-5.0); 3,819 incident TB cases were recorded (8.6%). At baseline, the median age was 34 years (IQR 28-41); 30,675 patients (69.3%) were female. The median CD4 cell count was 156 cells/µL (IQR 79-229) and the median HIV-RNA viral load 58,000 copies/mL (IQR 6,000-240,000). Overall TB incidence was 26.2/1,000 person-years (95% confidence interval [CI] 25.3-27.0). Compared to the lowest viral load category (0-999 copies/mL), the adjusted rate ratio for TB was 1.41 (95% CI 1.15-1.75, p < 0.001) in the highest group (>10,000 copies/mL). Time-updated analyses for CD4/HIV-RNA confirmed the association of viral load with the risk for TB.; Our results indicate that ongoing HIV replication is an important risk factor for TB, regardless of CD4 cell counts, and underline the importance of early ART start and retention on ART.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Medical Parasitology and Infection Biology (MPI) > Tuberculosis Research (Gagneux)
UniBasel Contributors:Fenner, Lukas and Ballif, Marie
Item Type:Article, refereed
Article Subtype:Research Article
ISSN:1758-2652
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:03 Oct 2017 07:34
Deposited On:03 Oct 2017 07:34

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