TY - JOUR
T1 - Tuberculosis incidence and mortality in people living with human immunodeficiency virus
T2 - a Danish nationwide cohort study
AU - Martin-Iguacel, Raquel
AU - Llibre, Josep M.
AU - Pedersen, Court
AU - Obel, Niels
AU - Stærke, Nina Breinholt
AU - Åhsberg, Johanna
AU - Ørsted, Iben
AU - Holden, Inge
AU - Kronborg, Gitte
AU - Mohey, Rajesh
AU - Rasmussen, Line Dahlerup
AU - Johansen, Isik Somuncu
N1 - 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.
PY - 2022/4
Y1 - 2022/4
N2 - 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.
AB - 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.
KW - Human immunodeficiency virus
KW - Immigration
KW - Mortality
KW - Social burden
KW - Tuberculosis
KW - Humans
KW - Risk Factors
KW - CD4 Lymphocyte Count
KW - Incidence
KW - Denmark/epidemiology
KW - HIV
KW - HIV Infections/complications
KW - Tuberculosis/complications
KW - Adult
KW - Cohort Studies
U2 - 10.1016/j.cmi.2021.07.036
DO - 10.1016/j.cmi.2021.07.036
M3 - Journal article
C2 - 34438070
AN - SCOPUS:85114180578
SN - 1198-743X
VL - 28
SP - 570
EP - 579
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 4
ER -