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HAART increased short-term risk for TB
Pettit AC. JAIDS. 2011;57:305–310.
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Low CD4+ lymphocyte count was associated with the risk for tuberculosis during the first 6 months of highly active antiretroviral therapy.
“The TB risk during the first 180 days after HAART initiation was higher (402/100,000 person-years) than the TB rate in those persons not on HAART (212/100,000 person-years) and those on HAART for more than 180 days (69/100,000 person-years),”April C. Pettit, MD, MPH, of Vanderbilt University Medical Center, and colleagues wrote. “However, the risk did not remain increased after adjusting for the most recent CD4+ lymphocyte count and HAART exposure.”
In the observational cohort study, Pettit and colleagues assessed the short- (<180 days) and long-term (>;180 days) effects of HAART on TB risk vs. no HAART in 4,534 patients with HIV who received care at the Comprehensive Care Center in Nashville, Tenn. between 1998 and 2008.
Of the 34 patients who developed TB, 17 cases were in patients on HAART and 17 in not on HAART. Of those on HAART, seven TB cases occurred after 6 months of HAART compared with 10 cases that occurred in patients on HAART for less than 6 months. Those with TB were more likely to be black, foreign-borne, male, and to report heterosexual contact as a risk factor for HIV.
After adjusting for the most recent CD4+ lymphocyte count, researchers observed no significant differences in TB risk between the groups (P=0.63).
“This study highlights the importance of screening for TB prior to initiating HAART,” Pettit told Infectious Disease News. “Second, it emphasizes the need to maintain a high clinical suspicion for TB shortly following HAART initiation, particularly among those persons with low CD4+ lymphocyte counts. Lastly, these results support the initiation of HAART at higher CD4+ lymphocyte counts to prevent TB disease. Our study had a low number of TB cases, therefore, future studies will need to assess the TB risk among a larger cohort of patients from a low TB incidence setting,” she said. – by Ashley DeNyse
Disclosure: Dr. Pettit reports no relevant financial disclosures.
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