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High rates of TB found in rural South African HIV treatment programs

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The rate of tuberculosis was high in rural KwaZulu-Natal, South Africa, treatment programs for patients with HIV receiving highly active antiretroviral therapy, regardless of pre-immunologic status and duration of therapy, according to the results of a prospective cohort study presented at the 2013 International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, Malaysia.

The study consisted of 969 patients with HIV who were eligible for HAART based on South African national antiretroviral program guidelines. Of those, 17.9% had active TB at the start of HAART (95% CI, 15.5-20.4). The rate of TB within the first 3 months of treatment after HAART was 11.5 per 100 person-years (95% CI, 7.1-17.5), which was three times higher than the rate 4 to 24 months after HAART (3.2 per 100 person-years; 95% CI, 2.2-4.5). The incidence rate ratio was 3.6 (P<.001).

The TB incidence rate in patients with CD4+ cell counts less than 50 cells/mm3 at initiation of treatment (5.3/100 person-years; 95% CI, 2.7-9.3) was not significantly different than in patients with CD4+ cell counts greater than 200 cells/mm3 (4.9/100 person-years; 95% CI, 2.4-9.0), indicating that immunologic status of patients did not affect TB incidence. There was a significant difference in CD4+ cell count gains 12 months after HAART initiation in patients with unmasking vs. incident TB (P=.03).

Females were associated with twofold the rates of unmasking TB (13.3/100 person-years; 95% CI, 7.6-21.3) than males (7.3/100 person-years; 95% CI, 2.0-18.8), with an incidence rate ratio of 1.8 (P=.21). The rate for patients aged 24 to 34 years was 17.8 per 100 person-years (95% CI, 10-29.4), nearly five times higher than those aged at least 35 years with a rate of 3.8 per 100 person-years (95% CI, 0.8-11.1). The incidence rate ratio was 4.7 (P=.01).

For more information:

Naidoo K. Abstract TUPDB0101. Presented at: 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention; June 30-July 03, 2013; Kuala Lumpur, Malaysia.