Search

1 | INTRODUCTION Despite the availability of effective antiretroviral therapy (ART), tuberculosis (TB) remains the leading cause of morbidity and mortality among people living with human immunodeficiency virus (PLWH). The [...], Introduction: Among high tuberculosis (TB) and HIV burden countries in Asia, tuberculosis preventive therapy (TPT) in people living with HIV (PLWH) has been underutilized despite its proven benefits independent of antiretroviral therapy (ART). Therefore, we determined the incidence of active TB and mortality among 9179 adult PLWH who attended and received ART from 15 tertiary care hospitals across Thailand. Methods: A retrospective study was conducted in 2018 using follow-up data from 1999 to 2018. The primary endpoint was incident TB disease after ART initiation. Factors associated with TB incidence were analysed using competing risk regression. The Kaplan-Meier method was used to estimate mortality after ART initiation. Results: During a median of 5.1 years of ART (IQR 2.2-9.5 years), 442 (4.8%) PLWH developed TB (TB/HIV), giving an over-all incidence of 750 (95% CI 683-823) per 100,000 persons-year of follow up (PYFU). In multivariate analysis, lower CD4 at ART initiation ([less than or equal to]100 cells/[mm.sup.3], adjusted sub-distribution hazard ratio [aSHR]: 2.08, 95% CI, 1.47-2.92; 101-200 cells/[mm.sup.3], aSHR: 2.21, 95% CI, 1.54-3.16; 201-350 cells/[mm.sup.3], aSHR: 1.59, 95% CI, 1.11-2.28 vs. >350 cells/[mm.sup.3]), male sex (aSHR: 1.40, 95% CI, 1.11-1.78), lower body weight ( Conclusions: In this high TB burden country, TB incidence was remarkably high during the first few years after ART initiation and thereafter decreased significantly. Rapid ART initiation and appropriate TPT can be potential key interventions to tackle the TB epidemic and reduce mortality among PLWH in TB/HIV high burden settings. Keywords: antiretroviral therapy; Asia; HIV; incident tuberculosis; latent TB infection; Thailand