17th International AIDS Conference Mexico City, Mexico - August 13 - 18, 2008

RISK FACTORS FOR TUBERCULOSIS WITHIN 3 MONTHS OF HAART INITIATION

Int Conf AIDS. 2008 Aug 13-18;17 Abstract No. MOAB0304

T. Sterling ¹, B. Merriman², A. Freeman², North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiological Databases to Evaluate AIDS (IeDEA)
¹Vanderbilt University, Division of Infectious Diseases, Nashville, United States, ²Johns Hopkins University, Baltimore, United States

BACKGROUND: TB risk in the first 3 months after HAART initiation is high, but associated risk factors are poorly understood. Once these risk factors are identified, targeted prevention strategies can be developed.

METHODS: Twelve cohorts in the U.S. and Canada contributed data on 9,937 HIV + persons who initiated HAART and for whom TB endpoints were assessed. Study period: Jan 1995-Mar 2006. TB prior to and in the same month as HAART initiation was excluded; persons with prior AIDS-defining events were not excluded. The association of demographic and clinical variables with TB occurring <3 vs. >3 months after HAART initiation was assessed by chi-squared and rank-sum tests.

RESULTS: TB incidence was 162/100,000 p-y (4 cases in 2469 p-y of follow-up) in the 1st 3 months of HAART and 84/100,000 p-y (38 cases in 45,322 p-y of follow-up) after 3 months of HAART (P=0.21; Poisson regression). Median follow-up after HAART start: 4.5 years. TB cases in the 1st 3 months had lower median CD4 at HAART start (54 vs. 138 cells/mm³, p=0.05) and higher median HIV-1 RNA (692,350 vs 72,884 c/ml, p=0.01) than persons with TB after 3 months. There was no difference by age, sex, race, site of disease (pulmonary vs. extrapulmonary), culture status (negative vs. positive), and HAART regimen (PI vs. NNRTI-based) in persons with early vs. delayed TB. One of 4(25%) early TB cases died vs. 8/38(21%) later TB cases (P=1.0). All 4 patients with TB in the 1st 3 months had baseline CD4 <100 and HIV-1 RNA >250,000 c/ml. 13% of all patients initiating HAART met these CD4 + HIV-1 RNA cutoffs.

CONCLUSIONS: The only factors associated with TB within 3 months of HAART initiation were low CD4 and high HIV-1 RNA. TB screening measures should be focused on persons with advanced AIDS, before and shortly after HAART initiation.

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2008-08-13
MOAB0304

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