Tuberculosis and the risk of opportunistic infections and cancers in HIV‐infected patients starting ART in Southern Africa

• Published in: Tropical medicine & international health 2013-02, Vol.18 (2), p.194-198
• Main Authors: Fenner, Lukas, Reid, Stewart E., Fox, Matthew P., Garone, Daniela, Wellington, Maureen, Prozesky, Hans, Zwahlen, Marcel, Schomaker, Michael, Wandeler, Gilles, Kancheya, Nzali, Boulle, Andrew, Wood, Robin, Henostroza, German, Egger, Matthias
• Format: Article
• Language: English
• Subjects: Adult; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - epidemiology; Anti-Retroviral Agents - adverse effects; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; antiretroviral treatment programmes; Bacterial diseases; Biological and medical sciences; Cancer; Epidemiology; Female; General aspects; history of tuberculosis; HIV; Human bacterial diseases; Human immunodeficiency virus; Human viral diseases; Humans; Incidence; Infections; Infectious diseases; Male; Medical sciences; Neoplasms - epidemiology; opportunistic infections; Proportional Hazards Models; Risk Factors; South Africa - epidemiology; Tuberculosis; Tuberculosis - epidemiology; Tuberculosis and atypical mycobacterial infections; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.12026

Objectives To investigate the incidence of selected opportunistic infections (OIs) and cancers and the role of a history of tuberculosis (TB) as a risk factor for developing these conditions in HIV‐infected patients starting antiretroviral treatment (ART) in Southern Africa. Methods Five ART programmes from Zimbabwe, Zambia and South Africa participated. Outcomes were extrapulmonary cryptococcal disease (CM), pneumonia due to Pneumocystis jirovecii (PCP), Kaposi's sarcoma and Non‐Hodgkin lymphoma. A history of TB was defined as a TB diagnosis before or at the start of ART. We used Cox models adjusted for age, sex, CD4 cell count at ART start and treatment site, presenting results as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Results We analysed data from 175 212 patients enrolled between 2000 and 2010 and identified 702 patients with incident CM (including 205 with a TB history) and 487 with incident PCP (including 179 with a TB history). The incidence per 100 person‐years over the first year of ART was 0.48 (95% CI 0.44–0.52) for CM, 0.35 (95% CI 0.32–0.38) for PCP, 0.31 (95% CI 0.29–0.35) for Kaposi's sarcoma and 0.02 (95% CI 0.01–0.03) for Non‐Hodgkin lymphoma. A history of TB was associated with cryptococcal disease (aHR 1.28, 95% CI 1.05–1.55) and Pneumocystis jirovecii pneumonia (aHR 1.61, 95% CI 1.27–2.04), but not with Non‐Hodgkin lymphoma (aHR 1.09, 95% CI 0.45–2.65) or Kaposi's sarcoma (aHR 1.02, 95% CI 0.81–1.27). Conclusions Our study suggests that there may be interactions between different OIs in HIV‐infected patients. Objectifs Etudier l'incidence de certaines d'infections opportunistes et de cancers et le rôle d'antécédents de tuberculose (TB) comme facteur de risque de développer ces affections chez les patients infectés par le VIH commençant un traitement antirétroviral (ART) en Afrique australe. Méthodes Cinq programmes ART au Zimbabwe, en Zambie et en Afrique du Sud ont participé à l’étude. Les résultats mesurés étaient la cryptococcose extra pulmonaire (CM), la pneumonie due à Pneumocystis jiroveci (PCP), le sarcome de Kaposi et le lymphome non hodgkinien. Un antécédent de TB a été défini comme un diagnostic de TB avant ou au début de l’ART. Nous avons utilisé des modèles de Cox ajustés pour l’âge, le sexe, le nombre de cellules CD4 au début de l’ART et le site de traitement, en présentant les résultats sous forme de rapports de risque ajustés (aHR) avec des intervalles de confiance (IC) à 95%. Résultats Nous avon