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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Infectious Diseases 1/2016

The incidence of tuberculosis among hiv-positive individuals with high CD4 counts: implications for policy

Zeitschrift:
BMC Infectious Diseases > Ausgabe 1/2016
Autoren:
Tendesayi Kufa, Violet Chihota, Victor Mngomezulu, Salome Charalambous, Suzanne Verver, Gavin Churchyard, Martien Borgdorff
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12879-016-1598-8) contains supplementary material, which is available to authorized users.

Abstract

Background

Intensified case finding (ICF) and earlier antiretroviral therapy (ART) initiation are strategies to reduce burden of HIV-associated tuberculosis (TB). We describe incidence of and associated factors for TB among HIV-positive individuals with CD4 counts > 350 cells/μl in South Africa.

Methods

Prospective cohort study of individuals recruited for a TB vaccine trial. Eligible individuals without prevalent TB were followed up at 6 and 12 months after enrolment. Cox proportional hazards regression was used to determine factors associated with risk of incident TB.

Results

Six hundred thirty-four individuals were included in the analysis [80.9 % female, 57.9 % on ART, median CD4 count 562 cells/μl (IQR 466–694 cells/μl)]. TB incidence was 2.7 per 100 person-years (pyrs) (95 % CI 1.6–4.4 per 100 pyrs) and did not differ significantly between those on ART and those not on ART [HR 0.65 (95 % CI 0.24–1.81)]. Low body mass index (BMI <18.5 kg/m2) was associated with incident TB [HR 3.87 (95 % CI 1.09–13.73)]. Half of the cases occurred in the first 6 months of follow up and may have been prevalent or incubating cases at enrolment.

Conclusions

TB incidence was high and associated with low BMI. Intensified case finding for TB should be strengthened for all HIV positive individuals regardless of their CD4 count or ART status.
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