Tuberculosis incidence and mortality in people living with human immunodeficiency virus: a Danish nationwide cohort study

Raquel Martin-Iguacel*, Josep M. Llibre, Court Pedersen, Niels Obel, Nina Breinholt Stærke, Johanna Åhsberg, Iben Ørsted, Inge Holden, Gitte Kronborg, Rajesh Mohey, Line Dahlerup Rasmussen, Isik Somuncu Johansen

*Kontaktforfatter

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Abstrakt

Objectives: To explore changes over time in the epidemiology of tuberculosis (TB) in Denmark in people living with human immunodeficiency virus (HIV) (PLWH). Methods: In this nationwide, population-based cohort study we included all adult PLWH from the Danish HIV Cohort Study (1995–2017) without previous TB. We estimated TB incidence rate (IR), all-cause mortality rate (MR), associated risk and prognostic factors using Poisson regression. Results: Among 6982 PLWH (73 596 person-years (PY)), we observed 217 TB events (IR 2.9/1000 PY, 95% CI 2.6–3.4: IR 6.7, 95% CI 5.7–7.9 among migrants and IR 1.4, 95% CI 1.1–1.7 among Danish-born individuals; p < 0.001). The IR of concomitant HIV/TB remained high and unchanged over time. The IR of TB diagnosed >3 months after HIV diagnosis declined with calendar time, longer time from HIV diagnosis, and CD4 cell recovery. Independent TB risk factors were African/Asian/Greenland origin (adjusted incidence rate ratio (aIRR) 5.2, 95% CI 3.5–7.6, aIRR 6.5, 95% CI 4.2–10.0, aIRR 7.0, 95% CI 3.4–14.6, respectively), illicit drug use (aIRR 6.9, 95% CI 4.2–11.2), CD4 <200 cells/μL (aIRR 2.7, 95% CI 2.0–3.6) and not receiving antiretroviral therapy (aIRR 3.7, 95% CI 2.5–5.3). Fifty-five patients died (MR 27.9/1000 PY, 95% CI 21.4–36.3), with no improvement in mortality over time. Mortality prognostic factors were Danish-origin (adjusted mortality rate ratio (aMRR) 2.3, 95% CI 1.3–4.3), social burden (aMRR 3.9, 95% CI 2.2–7.0), CD4 <100 cells/μL at TB diagnosis (aMRR 2.6, 95% CI 1.3–4.9), TB diagnosed >3 months after HIV versus concomitant diagnosis (aMRR 4.3, 95% CI 2.2–8.7) and disseminated TB (aMRR 3.3, 95% CI 1.1–9.9). Conclusion: Late HIV presentation with concomitant TB remains a challenge. Declining TB rates in PLWH were observed over time and with CD4 recovery, highlighting the importance of early and successful antiretroviral therapy. However, MR remained high. Our findings highlight the importance of HIV and TB screening strategies and treatment of latent TB in high-risk groups.

OriginalsprogEngelsk
TidsskriftClinical Microbiology and Infection
Vol/bind28
Udgave nummer4
Sider (fra-til)570-579
ISSN1198-743X
DOI
StatusUdgivet - apr. 2022

Bibliografisk note

Funding Information:
We thank our colleagues in our clinical departments for their continued contribution, their commitment and dedication. We would like to thank Claire Gudex for her assistance with language revision. We also thank the Danish AIDS foundation, the University of Southern Denmark, the Region of Southern Denmark, Odense University Hospital and Rigshopitalet for financial support. The Centres in the Danish HIV Cohort Study are as follows: Departments of Infectious Diseases at Copenhagen University Hospitals, Rigshospitalet (J. Gerstoft, N. Obel), Hvidovre (G. Kronborg) and Herlev Hospital (S. Lunding), Odense University Hospital (I.S.Johansen), Aarhus University Hospitals, Skejby (C.S. Larsen) and Aalborg (G. Pedersen), Herning Hospital (R. Mohey), Helsingor Hospital (L. Nielsen) and Kolding Hospital (J. Jensen).

Funding Information:
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work. This work was supported by scholarships from the University of Southern Denmark , the Region of Southern Denmark, and the Danish AIDS Foundation. The study was investigator-driven and therefore independent of any pharmaceutical company. The funding sources were not involved in study design, data collection, analyses, report writing or decision to submit the paper.

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