TB Risk Drops 6 Months After Starting Antiretroviral Treatment, Danish Study Finds
1 November 2024
Among people living with HIV in Denmark, tuberculosis risk remained at its highest level during the first six months after starting antiretroviral treatment, a newly published study found. Although risk levels dropped thereafter, TB incidence and mortality remained elevated among people who inject drugs and those who immigrated from areas with high tuberculosis prevalence, with implications for tuberculosis screening and treatment.
About This Study
“Risk of tuberculosis after achieving HIV virological suppression on antiretroviral therapy: a Danish nationwide prospective cohort study” was published online on Oct. 8, 2024, in Clinical Infectious Diseases. The lead author is Amrit Kaur Virdee, M.D., of the Department of Infectious Diseases at Odense University Hospital and of the Research Unit for Infectious Diseases at the University of Southern Denmark, both in Denmark.
Key Research Findings
This prospective cohort study investigated tuberculosis incidence, beginning six or more months after starting antiretroviral therapy, among 6,849 people living with HIV who started antiretroviral treatment in Denmark between 1995 and 2017. Seventy-six percent of participants were men, 77% of participants were Caucasian, and 13% of participants originally came from Africa.
Overall, 84 participants developed tuberculosis. Of these, 37% were born in Denmark, 36% were born in Africa, and 17% were born in Asia. Among the 54 participants who developed tuberculosis ≥6 months after starting HIV treatment, 32 migrated to Denmark, 13 were born in the country and injected drugs, and nine were born in the country but did not inject drugs. Forty-six percent of Danish-origin participants without injection drug use had a high risk for tuberculosis exposure, e.g., prison, homelessness.
The median follow-up was 7.4 years and the risk of a tuberculosis diagnosis was highest during the first six months of antiretroviral treatment. An exception was participants who inject drugs, in whom the diagnosis risk remained elevated. In addition, adjusted analyses revealed a higher tuberculosis rate among participants who migrated to Denmark and those with a prior AIDS-defining illness, and a lower rate among participants who were virally suppressed at baseline.
Tuberculosis treatment was completed by 91% of migrants, 92% of Danish participants who inject drugs, and 56% of Danish participants who do not inject drugs. The overall mortality rate was 32% for those who developed tuberculosis from six months after starting antiretroviral therapy and was highest among people who inject drugs and lower among migrants.
Discussion Highlights and Implications for Practice
Study limitations reported included the small sample size of participants with tuberculosis, the unavailability of some medical records from early in the study period, and the inability of the study design to analyze potentially confounding variables.
The relatively low treatment completion and high mortality rates among Danish-born people who do not inject drugs are likely due to social determinants of health, the researchers said. The study authors concluded that in countries with low tuberculosis prevalence, screening and prevention efforts should be focused on people living with HIV whose social determinants, country of origin, or injection drug use place them at elevated risk for the disease.
By Barbara Jungwirth
Source: TheBodyPro
