AEGiS-14IAC: How soon after HIV infection does the risk of TB start to rise? A retrospective cohort study in South African gold miners.

14th International AIDS Conference


Barcelona, Spain - July 7-12, 2002

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How soon after HIV infection does the risk of TB start to rise? A retrospective cohort study in South African gold miners.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. MoOrC1102)

Sonnenberg P, Glynn JR, Fielding K, Godfrey-Faussett P, Murray J, Shearer S
London School of Hygiene &Tropical Medicine, London, United Kingdom

BACKGROUND: HIV increases the risk of tuberculosis (TB), but no study has assessed how soon after infection with HIV this risk starts to rise and how it changes with duration of infection. This is essential for planning interventions and estimating disease burden.

METHODS: The incidence of pulmonary TB was estimated in miners with and without HIV infection using a retrospective cohort study design. All miners who had an HIV test performed between 1991 and 1997 were eligible. We linked HIV results to the routinely collected database of cases with TB and to demographic and occupational information. Using survival analysis, the variation in the rate ratio (RR) of TB in HIV positive versus HIV negative miners was estimated by duration of HIV infection, calendar time and age.

RESULTS: Of the 23875 subjects in the cohort, 17764 were HIV negative, 3371 were HIV positive on entry and 2740 subjects seroconverted during the follow-up period, of whom |1967 had seroconversion intervals of less than 2 years. There were 740 cases of TB. The incidence of TB increased with HIV, age and calender period. TB incidence was 2.90/100 pyar in HIV positive and 0.80/100 pyar in HIV negative miners: RR (adjusted for age and calender period) 2.9, 95% CI 2.5-3.4. Comparing those with seroconversion dates known within 2 years and those who were HIV negative showed a doubling in the incidence of TB within the first year of HIV infection (adjusted RR 2.1; 1.5-3.1), with only slight further increase in those infected for longer periods, up to 7 years (p value for trend with duration of infection = 0.09).

CONCLUSION: The increase in the risk of TB so soon after infection with HIV was unexpected and suggests current mathematical models of TB are underestimating the effects of HIV.

Keywords: AEGIS, Cohort Studies, HIV Infections, Gold, Retrospective Studies, Mining, Incidence, Tuberculosis, Tuberculosis, Pulmonary, HIV Seropositivity, EpidemiologyKWDaegis,cohortstudies,hivinfections,gold,retrospectivestudies,mining,incidence,tuberculosis,tuberculosis,pulmonary,hivseropositivity,epidemiology

020707
MoOrC1102

Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.