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Ahmed A, Mekonnen D, Shiferaw AM, Belayneh F, Yenit MK. Incidence and determinants of tuberculosis infection among adult patients with HIV attending HIV care in north-east Ethiopia: a retrospective cohort study. BMJ Open 2018; 8:e016961. [PMID: 29437750 PMCID: PMC5829770 DOI: 10.1136/bmjopen-2017-016961] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/13/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study assessed the incidence of tuberculosis (TB) and its predictors among adults living with HIV/AIDS in government health facilities in north-east Ethiopia. SETTING A 5-year retrospective cohort study was conducted from May to June 2015 on 451 adult HIV/AIDS-infected individuals who enrolled in the HIV care clinics of government health facilities in north-east Ethiopia. PARTICIPANTS A total of 451 HIV-infected adults who newly enrolled in the adult HIV care clinic from 1 July 2010 with complete information were followed until May 2015. PRIMARY OUTCOME MEASURE The primary outcome was the proportion of patients diagnosed with TB or the TB incidence rate. SECONDARY OUTCOME MEASURE The incidence of TB was investigated in relation to years of follow-up. RESULTS A total of 451 charts with complete information were followed for 1377.41 person-years (PY) of observation. The overall incidence density of TB was 8.6 per 100 PYof observation. Previous TB disease (adjusted HR (AHR) 3.65, 95% CI 1.97 to 6.73), being bedridden (AHR 5.45, 95% CI 1.16 to 25.49), being underweight (body mass index (BMI) <18.5 kg/m2) (AHR 2.53, 95 % CI 1.27 to 5.05), taking isoniazid preventive therapy (IPT) (AHR 0.14, 95% CI 0.05 to 0.39), haemoglobin below 11 g/dL (AHR 2.31, 95% CI 1.35 to 3.93), and being in WHO clinical stages III and IV (AHR 2.84, 95% CI 1.11 to 7.27; AHR 3.07, 95% CI 1.08 to 8.75, respectively) were significant for the incidence of TB. CONCLUSION The incidence of TB among adults living with HIV/AIDS in the first 3 years of follow-up was higher compared with that of subsequent years. Previous TB disease, no IPT, low BMI and haemoglobin level, advanced WHO clinical stage, and bedridden condition were the determinants of the incidence of TB. Therefore, addressing the significant predictors and improving TB/HIV collaborative activities should be strengthened in the study setting.
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Affiliation(s)
- Ausman Ahmed
- Department of Public Health, Jigjiga University, Jigjiga, Ethiopia
| | - Desalew Mekonnen
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atsede M Shiferaw
- Department of Health Informatics, University of Gondar, Gondar, Ethiopia
| | - Fanuel Belayneh
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Melaku K Yenit
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
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Injecting drug use predicts active tuberculosis in a national cohort of people living with HIV. AIDS 2017; 31:2403-2413. [PMID: 28857827 DOI: 10.1097/qad.0000000000001635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Tuberculosis (TB) is common in people living with HIV, leading to worse clinical outcomes including increased mortality. We investigated risk factors for developing TB following HIV diagnosis. DESIGN Adults aged at least 15 years first presenting to health services for HIV care in England, Wales or Northern Ireland from 2000 to 2014 were identified from national HIV surveillance data and linked to TB surveillance data. METHODS We calculated incidence rates for TB occurring more than 91 days after HIV diagnosis and investigated risk factors using multivariable Poisson regression. RESULTS A total of 95 003 adults diagnosed with HIV were followed for 635 591 person-years; overall incidence of TB was 344 per 100 000 person-years (95% confidence interval 330-359). TB incidence was high for people who acquired HIV through injecting drugs [PWID; men 876 (696-1104), women 605 (365-945)] and black Africans born in high TB incidence countries [644 (612-677)]. The adjusted incidence rate ratio for TB amongst PWID was 4.79 (3.35-6.85) for men and 6.18 (3.49-10.93) for women, compared with MSM. The adjusted incidence rate ratio for TB in black Africans from high-TB countries was 4.27 (3.42-5.33), compared with white UK-born individuals. Lower time-updated CD4 cell count was associated with increased rates of TB. CONCLUSION PWID had the greatest risk of TB; incidence rates were comparable with those in black Africans from high TB incidence countries. Most TB cases in PWID were UK-born, and likely acquired TB through transmission within the United Kingdom. Earlier HIV diagnosis and quicker initiation of antiretroviral therapy should reduce TB incidence in these populations.
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Grossman Z, Avidor B, Mor Z, Chowers M, Levy I, Shahar E, Riesenberg K, Sthoeger Z, Maayan S, Shao W, Lorber M, Olstein-Pops K, Elbirt D, Elinav H, Asher I, Averbuch D, Istomin V, Gottesman BS, Kedem E, Girshengorn S, Kra-Oz Z, Shemer Avni Y, Radian Sade S, Turner D, Maldarelli F. A Population-Structured HIV Epidemic in Israel: Roles of Risk and Ethnicity. PLoS One 2015; 10:e0135061. [PMID: 26302493 PMCID: PMC4547742 DOI: 10.1371/journal.pone.0135061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/17/2015] [Indexed: 11/30/2022] Open
Abstract
Background HIV in Israel started with a subtype-B epidemic among men who have sex with men, followed in the 1980s and 1990s by introductions of subtype C from Ethiopia (predominantly acquired by heterosexual transmission) and subtype A from the former Soviet Union (FSU, most often acquired by intravenous drug use). The epidemic matured over the last 15 years without additional large influx of exogenous infections. Between 2005 and 2013 the number of infected men who have sex with men (MSM) increased 2.9-fold, compared to 1.6-fold and 1.3-fold for intravenous drug users (IVDU) and Ethiopian-origin residents. Understanding contemporary spread is essential for effective public health planning. Methods We analyzed demographic and virologic data from 1,427 HIV-infected individuals diagnosed with HIV-I during 1998–2012. HIV phylogenies were reconstructed with maximum-likelihood and Bayesian methods. Results Subtype-B viruses, but not A or C, demonstrated a striking number of large clusters with common ancestors having posterior probability ≥0.95, including some suggesting presence of transmission networks. Transmitted drug resistance was highest in subtype B (13%). MSM represented a frequent risk factor in cross-ethnic transmission, demonstrated by the presence of Israeli-born with non-B virus infections and FSU immigrants with non-A subtypes. Conclusions Reconstructed phylogenetic trees demonstrated substantial grouping in subtype B, but not in non-MSM subtype-A or in subtype-C, reflecting differences in transmission dynamics linked to HIV transmission categories. Cross-ethnic spread occurred through multiple independent introductions, with MSM playing a prevalent role in the transmission of the virus. Such data provide a baseline to track epidemic trends and will be useful in informing and quantifying efforts to reduce HIV transmission.
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Affiliation(s)
- Zehava Grossman
- School of Public Health, Tel-Aviv University, Tel-Aviv, Israel
- National Cancer Institute, Frederick, MD, United States of America
- * E-mail:
| | - Boaz Avidor
- Crusaid Kobler AIDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Laboratory of Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zohar Mor
- Ramla Department of Health, Ministry of Health, Ramla, Israel
| | | | - Itzchak Levy
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | | | | | | | | | - Wei Shao
- Advanced Biomedical Computing Center, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, United States of America
| | | | | | | | | | | | | | | | | | | | - Shirley Girshengorn
- Crusaid Kobler AIDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Laboratory of Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Dan Turner
- Crusaid Kobler AIDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Frank Maldarelli
- National Cancer Institute, Frederick, MD, United States of America
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Musa BM, Musa B, Muhammed H, Ibrahim N, Musa AG. Incidence of tuberculosis and immunological profile of TB/HIV co-infected patients in Nigeria. Ann Thorac Med 2015; 10:185-92. [PMID: 26229561 PMCID: PMC4518349 DOI: 10.4103/1817-1737.160838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/08/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND: We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HIV Treatment. We also modeled the relationship between incident TB and change in CD4 count over the follow-up period. METHODS: We analyzed the incidence of TB over 10 years from initiation of HIV treatment among 345 HIV treatment-naïve persons, who were enrolled in a cohort in Kano, Nigeria. We used Generalized Estimating Equation [GEE] to identify determinants of TB incidence and model the relationship between the occurrences of TB with change in CD4 count over the follow-up period. We created Kaplan-Meier curves stratified by anti-retroviral therapy (ART) treatment failure status to examine the effect of first line ART treatment failure on occurrence of TB. RESULT: During the 10-year period, 47(13.62%) had TB [incidence was 7.43 per (1,000) person year)]. It is associated with decreasing age (OR = 0.98), female gender (OR = 0.83), being on first line ART other than AZT (OR = 0.87), poor adherence (OR = 1.25), change in ART regimen (OR = 2.3) and ART treatment failure (OR = 1.51). Odds of TB occurrence was also associated with CD4 increment at 10 years (OR = 0.99). Those with TB/HIV co-infection tend to have statistically significant shorter time to failing first line ART regimen compared to those with HIV infection alone. CONCLUSION: There was high incidence of TB in the studied HIV cohort with a deleterious effect on the outcome of ART treatment. There is need for early TB screening and re-screening among all HIV patients.
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Affiliation(s)
- Baba Maiyaki Musa
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Babashani Musa
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Hamza Muhammed
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Nashabaru Ibrahim
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
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Tuberculosis in native Israeli Arabs and Jews: trends and treatment outcomes, 1999-2011. Epidemiol Infect 2015; 143:3203-10. [PMID: 25881717 DOI: 10.1017/s0950268815000382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The incidence of tuberculosis (TB) in native ethnic minorities remains high in developed countries. Arabs, the major ethnic minority in Israel, comprise 21% of its population. This retrospective study compared TB incidence, demographic, clinical, laboratory, genotyping characteristics and treatment outcomes in all Israeli-born citizens diagnosed with TB between 1999 and 2011 by ethnicity, i.e. Israeli-born Arabs (IA) and Jews (IJ). A total of 831 Israeli-born TB patients were reported. Of those, there were 530 (64%) IJ and 301 (36%) IA, with an average annual TB rate of 1·1 and 1·6 cases/100 000 population, respectively, lower than the national average (7·0 cases/100 000 population). TB rates in IA and IJ declined and converged to 1 case/100 000 residents. IA TB patients were more likely to be older, have more pulmonary TB and have lower treatment success rates than IJ. Older age and HIV co-infection, but not ethnicity, were predictive of non-success in TB treatment. Ten mixed IA-IJ clades were detected by spoligotyping and three mixed IA-IJ clusters were identified by MIRU-VNTR typing. Only one IA-IJ couple recalled mutual contact. In conclusion, TB rate in IA was higher than in IJ, but declined and converged in both to 1 case/100 000. Treatment success was high in both groups, and was unrelated to ethnicity.
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