Risk factors for tuberculosis in HIV-infected persons: A prospective cohort study

G. Antonucci, E. Girardi, M. C. Raviglione, G. Ippolito

Research output: Contribution to journalArticle

209 Citations (Scopus)

Abstract

Objective: To analyze how demographic, clinical, and laboratory characteristics influence the risk of tuberculosis in human immunodeficiency virus (HIV)infected individuals; to examine the incidence of tuberculosis associated with change in skin test responsiveness in HIV-infected, tuberculin-negative, nonanergic individuals. Design: Mutlicenter cohort study. Setting: Twenty-three infectious disease units in public hospitals in Italy. Subjects: A consecutive sample of 3397 HIV-infected subjects were considered for entry in the study. Of these, 2695 who were followed u p for at least 4 weeks were enrolled in the study; 739 subjects (27.4%) were unavailable for follow-up. The median duration of follow-up was 91 weeks. Main Outcome Measure: Culture-proven tuberculosis. Results: Eighty-three episodes of tuberculosis were observed. Incidence rates of tuberculosis were 5.42 per 100 person-years among tuberculin-positive subjects, 3.00 per 100 person-years among anergic subjects, and 0.45 per 100 person-years among tuberculin-negative nonanergic subjects. In multivariate analysis, being tuberculin-positive (hazard ratio [HR], 9.94; 95% confidence interval [CI], 3.84 to 25.72) or anergic (HR, 3.35; 95% CI, 1.40 to 8.00), or having a CD4+ lymphocyte count lees than 0.20x109/L (HR, 4.87; 95% CI, 2.35 to 10.11) or between 0.20 and 0.35x109/L (HR, 2.35; 95% CI, 1.09 to 5.05) were statistically significantly associated with the risk of tuberculosis. Incidence of tuberculosis increased with decreasing levels of CD4+ lymphocytes in the three groups of subjects with different skin test responsiveness. Skin tests were repeated 1 year after enrollment in 604 tuberculin-negative nonanergic subjects; three cases of tuberculosis were observed among the 13 subjects who converted to tuberculin reactivity. Conclusions: Risk of tuberculosis in HIV-infected persons can be more precisely quantified by jointly considering skin test reactivity and CD4+ lymphocyte count. Periodic skin tests in tuberculin-negative nonanergic individuals can be useful in identifying individuals at high risk of active tuberculosis.

Original languageEnglish
Pages (from-to)143-148
Number of pages6
JournalJournal of the American Medical Association
Volume274
Issue number2
Publication statusPublished - 1995

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Tuberculosis
Cohort Studies
Tuberculin
HIV
Prospective Studies
Skin Tests
Confidence Intervals
CD4 Lymphocyte Count
Incidence
Public Hospitals
Italy
Communicable Diseases
Multivariate Analysis
Demography
Outcome Assessment (Health Care)
Lymphocytes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Risk factors for tuberculosis in HIV-infected persons : A prospective cohort study. / Antonucci, G.; Girardi, E.; Raviglione, M. C.; Ippolito, G.

In: Journal of the American Medical Association, Vol. 274, No. 2, 1995, p. 143-148.

Research output: Contribution to journalArticle

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abstract = "Objective: To analyze how demographic, clinical, and laboratory characteristics influence the risk of tuberculosis in human immunodeficiency virus (HIV)infected individuals; to examine the incidence of tuberculosis associated with change in skin test responsiveness in HIV-infected, tuberculin-negative, nonanergic individuals. Design: Mutlicenter cohort study. Setting: Twenty-three infectious disease units in public hospitals in Italy. Subjects: A consecutive sample of 3397 HIV-infected subjects were considered for entry in the study. Of these, 2695 who were followed u p for at least 4 weeks were enrolled in the study; 739 subjects (27.4{\%}) were unavailable for follow-up. The median duration of follow-up was 91 weeks. Main Outcome Measure: Culture-proven tuberculosis. Results: Eighty-three episodes of tuberculosis were observed. Incidence rates of tuberculosis were 5.42 per 100 person-years among tuberculin-positive subjects, 3.00 per 100 person-years among anergic subjects, and 0.45 per 100 person-years among tuberculin-negative nonanergic subjects. In multivariate analysis, being tuberculin-positive (hazard ratio [HR], 9.94; 95{\%} confidence interval [CI], 3.84 to 25.72) or anergic (HR, 3.35; 95{\%} CI, 1.40 to 8.00), or having a CD4+ lymphocyte count lees than 0.20x109/L (HR, 4.87; 95{\%} CI, 2.35 to 10.11) or between 0.20 and 0.35x109/L (HR, 2.35; 95{\%} CI, 1.09 to 5.05) were statistically significantly associated with the risk of tuberculosis. Incidence of tuberculosis increased with decreasing levels of CD4+ lymphocytes in the three groups of subjects with different skin test responsiveness. Skin tests were repeated 1 year after enrollment in 604 tuberculin-negative nonanergic subjects; three cases of tuberculosis were observed among the 13 subjects who converted to tuberculin reactivity. Conclusions: Risk of tuberculosis in HIV-infected persons can be more precisely quantified by jointly considering skin test reactivity and CD4+ lymphocyte count. Periodic skin tests in tuberculin-negative nonanergic individuals can be useful in identifying individuals at high risk of active tuberculosis.",
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