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1 January 2007

Volume 44, Number 1
Clinical Infectious Diseases 2007;44:94–102
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4401-0017$15.00
DOI: 10.1086/510080
HIV/AIDS MAJOR ARTICLE

Reducing Tuberculosis Incidence by Tuberculin Skin Testing, Preventive Treatment, and Antiretroviral Therapy in an Area of Low Tuberculosis Transmission

Luigia Elzi,1

Matthias Schlegel,2

Rainer Weber,3

Bernard Hirschel,4

Matthias Cavassini,5

Patrick Schmid,7

Enos Bernasconi,8

Martin Rickenbach,6 and

Hansjakob Furrer,2 and the

Swiss HIV Cohort Studya

1University Hospital Basel, Basel, 2University Hospital Berne, Berne, 3University Hospital Zurich, Zurich, 4University Hospital Geneva, Geneva, 5University Hospital Lausanne and 6Swiss HIV Cohort Study Data Center, Lausanne, 7Cantonal Hospital St. Gall, St. Gall, and 8Ospedale Regionale di Lugano, Lugano, Switzerland

Background.Tuberculin skin testing (TST) and preventive treatment of tuberculosis (TB) are recommended for all persons with human immunodeficiency virus (HIV) infection. We aimed to assess the effect of TST and preventive treatment of TB on the incidence of TB in the era of combination antiretroviral therapy in an area with low rates of TB transmission.

Methods.We calculated the incidence of TB among participants who entered the Swiss HIV Cohort Study after 1995, and we studied the associations of TST results, epidemiological and laboratory markers, preventive TB treatment, and combination antiretroviral therapy with TB incidence.

Results.Of 6160 participants, 142 (2.3%) had a history of TB at study entry, and 56 (0.91%) developed TB during a total follow‐up period of 25,462 person‐years, corresponding to an incidence of 0.22 cases per 100 person‐years. TST was performed for 69% of patients; 9.4% of patients tested had positive results (induration 5 mm in diameter). Among patients with positive TST results, TB incidence was 1.6 cases per 100 person‐years if preventive treatment was withheld, but none of the 193 patients who received preventive treatment developed TB. Positive TST results (adjusted hazard ratio [HR], 25; 95% confidence interval [CI], 11–57), missing TST results (HR, 12; 95% CI, 4.8–20), origin from sub‐Saharan Africa (HR, 5.8; 95% CI, 2.7–12.5), low CD4+ cell counts, and high plasma HIV RNA levels were associated with an increased risk of TB, whereas the risk was reduced among persons receiving combination antiretroviral therapy (HR, 0.44; 95% CI, 0.2–0.8).

Conclusion.Screening for latent TB using TST and administering preventive treatment for patients with positive TST results is an efficacious strategy to reduce TB incidence in areas with low rates of TB transmission. Combination antiretroviral therapy reduces the incidence of TB.

Received 1 August 2006; accepted 11 September 2006; electronically published 28 November 2006.

  • (See the editorial commentary by Reider on pages 103–4)

Reprints or correspondence: Dr. Hansjakob Furrer, Klinik und Poliklinik für Infektiologie, University Hospital Berne, Inselspital PKT2 B, CH‐3010 Bern ().

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Jonathan E Golub, Jacquie Astemborski, Mohammed Ahmed, Wendy Cronin, Shruti H Mehta, Gregory D Kirk, David Vlahov, Richard E Chaisson. (2009) Long-Term Effectiveness of Diagnosing and Treating Latent Tuberculosis Infection in a Cohort of HIV-Infected and At-Risk Injection Drug Users. JAIDS Journal of Acquired Immune Deficiency Syndromes 49:5, 532-537
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J Lucian Davis, Matthew Fei, Laurence Huang. (2008) Respiratory infection complicating HIV infection. Current Opinion in Infectious Diseases 21:2, 184-190
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Luigia Elzi and Hansjakob Furrer. (2007) Reply to Hamlyn et al.. Clinical Infectious Diseases 44:10, 1394-1395
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Elizabeth Hamlyn, Kate Childs, and Frank A. Post. (2007) Reducing Tuberculosis Incidence in HIV‐Infected Patients by Tuberculin Skin Testing, Preventive Treatment, and Antiretroviral Therapy. Clinical Infectious Diseases 44:10, 1393-1394
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Hans L. Rieder. (2007) Editorial Commentary: Preventing Latent Tuberculosis among HIV‐Infected Patients: Efficacious and Effective, yet Inefficient?. Clinical Infectious Diseases 44:1, 103-104
Online publication date: 1-Jan-2007.
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