Publication details

HIV replication and tuberculosis risk among people living with HIV in Europe: A multicohort analysis, 1983–2015

Authors	ATKINSON Andrew KRAUS David BANHOLZER Nicolas MIRO Jose M. REISS Peter KIRK Ole MUSSINI Cristina MORLAT Philippe PODLEKAREVA Daria GRANT Alison D. SABIN Caroline VAN DER VALK Marc LE MOING Vincent MEYER Laurence SENG Remonie CASTAGNA Antonella OBEL Niels ANTONIADOU Anastasia SALMON Dominique ZWAHLEN Marcel EGGER Matthias DE WIT Stephane FURRER Hansjakob FENNER Lukas
Year of publication	2024
Type	Article in Periodical
Magazine / Source	PLoS ONE
MU Faculty or unit	Faculty of Science
Citation
Web	https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0312035
Doi	http://dx.doi.org/10.1371/journal.pone.0312035
Keywords	Tuberculosis; HIV; Medical risk factors; HIV epidemiology; Europe; Epidemiology; Viral load; Tuberculosis diagnosis and management
Description	Introduction HIV replication leads to a change in lymphocyte phenotypes that impairs immune protection against opportunistic infections. We examined current HIV replication as an independent risk factor for tuberculosis (TB). Methods We included people living with HIV from 25 European cohorts 1983–2015. Individuals <16 years or with previous TB were excluded. Person-time was calculated from enrolment (baseline) to the date of TB diagnosis or last follow-up information. We used adjusted Poisson regression and general additive regression models. Results We included 272,548 people with a median follow-up of 5.9 years (interquartile range [IQR] 2.3–10.9). At baseline, the median CD4 cell count was 355 cells/µL (IQR 193–540) and the median HIV-RNA level 22,000 copies/mL (IQR 1,300–103,000). During 1,923,441 person-years of follow-up, 5,956 (2.2%) people developed TB. Overall, TB incidence was 3.1 per 1,000 person-years (95% confidence interval [CI] 3.02–3.18) and was four times higher in patients with HIV-RNA levels of 10,000 compared with levels <400 copies/mL in any CD4 stratum. CD4 and HIV-RNA time-updated analyses showed that the association between HIV-RNA and TB incidence was independent of CD4. The TB incidence rate ratio for people born in TB-endemic countries compared with those born in Europe was 1.8 (95% CI 1.5–2.2). Conclusions Our results indicate that ongoing HIV replication (suboptimal HIV control) is an important risk factor for TB, independent of CD4 count. Those at highest risk of TB are people from TB-endemic countries. Close monitoring and TB preventive therapy for people with suboptimal HIV control is important.