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Impact of Combination Antiretroviral Therapy on the Risk of Tuberculosis among Persons with HIV E. GIRARDI, G. ANTONUCCI, P. VANACORE, M. LIBANORE,, I. ERRANTE , A. MATTEELLI, G. IPPOLITO*, and GISTA Study Group.
IRCCS Spallanzani, Rome, Italy Background: The HIV epidemic has substantially contributed to the resurgence of tuberculosis. Increasing use of combination antiretroviral therapy determined a substantial decrease in the incidence of HIV-associated illnesses in several industrialized countries. However, the impact of new antiretroviral therapies on the risk of tuberculosis among HIV-infected persons has not been directly evaluated.
Methods:: We analyzed data of 1360 HIV-infected individuals enrolled in 1995-1996 in an observational, multicenter, prospective study on implementation of tuberculosis preventive therapy. Study participants were followed up until 1998. Enrolled individuals were tested for tuberculin reactivity at base-line, and information on the use of antiretroviral therapies over time was collected .We evaluated the association between different antiretroviral regimens and incidence of tuberculosis
Results: We observed 18 cases of tuberculosis, with an overall incidence rate of 0.79 per 100 person years of observation (95% CI 0.51-1.31). Tuberculin positivity and low CD4+ cell count were the only base-line variables independently associated with the risk of tuberculosis. During follow-up, 637 patients took double combination antiretroviral therapy and 387 triple combination therapy. After adjusting for tuberculin reactivity and CD4+ cell count, the relative hazard of tuberculosis was 0.18 (0.04-0.83) for double combination therapy and 0.09 (0.01-0.88) for triple combination therapy compared to no therapy or monotherapy.
Conclusions: Combination antiretroviral therapy significantly reduces the risk of tuberculosis in HIV-infected persons. Widespread use of this treatment may determine a decrease in the incidence of HIV-associated tuberculosis, and could possibly contribute to a reduction in overall incidence of tuberculosis, in industrialized countries.
Key Words: Antiretrovirals, Cohort studies, Tuberculosis
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