The contribution of late HIV diagnosis on the occurrence of HIV-associated tuberculosis

Musaazi, Joseph; Castelnuovo, Barbara; D'arminio Monforte, Antonella; Gotuzzo Herencia, José Eduardo; Carriquiry, Gabriela; Caro-Vega, Yanink; Cozzi-Lepri, Alessandro; Gori, Andrea; Crabtree-Ramirez, Brenda; Mussini, Cristina; Manabe, Yukari C.; Girardi, Enrico

dc.contributor.author	Girardi, Enrico
dc.contributor.author	Caro-Vega, Yanink
dc.contributor.author	Cozzi-Lepri, Alessandro
dc.contributor.author	Musaazi, Joseph
dc.contributor.author	Carriquiry, Gabriela
dc.contributor.author	Castelnuovo, Barbara
dc.contributor.author	Gori, Andrea
dc.contributor.author	Manabe, Yukari C.
dc.contributor.author	Gotuzzo Herencia, José Eduardo
dc.contributor.author	D'arminio Monforte, Antonella
dc.contributor.author	Crabtree-Ramirez, Brenda
dc.contributor.author	Mussini, Cristina
dc.date.accessioned	2022-11-15T23:04:43Z
dc.date.available	2022-11-15T23:04:43Z
dc.date.issued	2022
dc.identifier.uri	https://hdl.handle.net/20.500.12866/12627
dc.description.abstract	OBJECTIVES: To describe the timing of tuberculosis (TB) presentation in relation to diagnosis of HIV infection and antiretroviral therapy (ART) initiation and to evaluate whether the established impact from late presentation to care and late initiation of ART on the risk of TB is retained beyond the observation period of clinical trials. DESIGN: We used marginal structural models to emulate a clinical trial with up to 5 years of follow-up to evaluate the impact of late initiation on TB risk. METHODS: People with HIV (PWH) were enrolled from 2007 to 2016 in observational cohorts from Uganda, Peru, Mexico and Italy. The risk of TB was compared in LP (accessing care with CD4 + cell count ≤350 cells/μl) vs. nonlate presentation using survival curves and a weighted Cox regression. We emulated two strategies: initiating ART with CD4 + cell count less than 350 cells/μl vs. CD4 + cell count at least 350 cells/μl (late initiation). We estimated TB attributable risk and population attributable fraction up to 5 years from the emulated date of randomization. RESULTS: Twenty thousand one hundred and twelve patients and 1936 TB cases were recorded. Over 50% of TB cases were diagnosed at presentation for HIV care. More than 50% of the incident cases of TB after ART initiation were attributable to late presentation; nearly 70% of TB cases during the first year of follow-up could be attributed to late presentation and more than 50%, 5 years after first attending HIV care. CONCLUSION: Late presentation accounted for a large share of TB cases. Delaying ART initiation was detrimental for incident TB rates, and the impact of late presentation persisted up to 5 years from HIV care entry.	en_US
dc.language.iso	eng
dc.publisher	Wolters Kluwer Health
dc.relation.ispartofseries	AIDS
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	co-infection	en_US
dc.subject	delayed antiretroviral therapy initiation	en_US
dc.subject	HIV	en_US
dc.subject	low-income and middle-income countries	en_US
dc.subject	tuberculosis	en_US
dc.title	The contribution of late HIV diagnosis on the occurrence of HIV-associated tuberculosis	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1097/QAD.0000000000003321
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn	1473-5571