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Published ahead of print on April 1, 2005, doi:10.1164/rccm.200410-1342OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 1, July 2005, 123-127

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Submitted on October 11, 2004
Accepted on March 23, 2005

Risk Factors for Active Tuberculosis Following Antiretroviral Treatment Initiation in Abidjan

Catherine Seyler1, Siaka Toure1, Eugene Messou1, Dominique Bonard2, Delphine Gabillard3, and Xavier Anglaret4*

1 Programme PAC-CI, Abidjan, Cote d'Ivoire, 2 Programme PAC-CI, Abidjan, Cote d'Ivoire; Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire de Treichville, Abidjan, Cote d'Ivoire, 3 Universite Victor Segalen Bordeaux 2, INSERM U593, Bordeaux, France, 4 Programme PAC-CI, Abidjan, Cote d'Ivoire; Universite Victor Segalen Bordeaux 2, INSERM U593, Bordeaux, France

* To whom correspondence should be addressed. E-mail: Xavier.Anglaret{at}isped.u-bordeaux2.fr.

Rationale: In sub-Saharan Africa: (i) tuberculosis is the first cause of HIV-related mortality; (ii) the incidence of tuberculosis in adults receiving highly active antiretroviral therapy (HAART) is lower than in untreated HIV-infected adults but higher than in HIV-negative adults; (iii) factors associated with the occurrence of tuberculosis in patients receiving HAART have never been described. Objective: To look for the risk factors for active tuberculosis in HIV-infected adults receiving HAART in Abidjan. Methods: Seven-year prospective cohort of HIV-infected adults, with standardized procedures for documenting morbidity. We analyzed: (i) the incidence of active tuberculosis in patients who started HAART; (ii) the association between the occurrence of tuberculosis and the characteristics of these patients at HAART initiation. Main results: 129 adults (median baseline CD4 count 125/mm3) started HAART and were then followed up during 270 person-years (P-Y). At HAART initiation, 31 had a past history of tuberculosis and none had current active tuberculosis. During follow-up, the incidence of active tuberculosis was 4.8/100 P-Y (95%CI 2.5-8.3) overall, 3.0/100 P-Y (95%CI 1.1-6.6) in patients with no tuberculosis history, and 11.3/100 P-Y (95%CI 4.1-24.5) in patients with a history of tuberculosis (Adjusted Hazard Ratio 4.64, 95%CI, 1.29-16.62, p=0.02). Conclusion: The risk of tuberculosis after HAART initiation was significantly higher in patients with a past history of tuberculosis than in those with no tuberculosis history. If confirmed by others, this finding could lead to assessment of new patterns of time-limited tuberculosis secondary chemoprophylaxis during the period of initiation of HAART in sub-Saharan African adults.
Key words: HIV; Africa South of the Sahara; HAART; risk-factors; adults; tuberculosis; incidence




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