Incidence of tuberculosis in HIV-infected patients in Spain: the impact of treatment for LTBI.

MORE THAN other risk factors, human immunode" ciency virus (HIV) infection contributes to an increased risk of progression from latent tuberculous infection (LTBI) to active tuberculosis (TB).1 In persons without TB, the tuberculin skin test (TST) is the standard method used to identify LTBI,1 although among HIV-infected patients with low CD4+ cell SETT ING : Twenty hospitals in Spain. OBJECT IVE : To describe the incidence of active tuberculosis (TB) and factors related to TB development after treatment for latent tuberculous infection (TLTBI) in human immunodeficiency virus-1 (HIV-1) infected patients in the highly active antiretroviral therapy era. DES IGN : In a multicentre cohort of HIV-1-infected patients, we calculated TB incidence by tuberculin skin test (TST) results and TLTBI, and factors associated with a positive TST and the development of TB after TLTBI. RESULTS : Of 7902 patients, 6.5% had a history of TB at enrolment: 168 patients developed TB during 10 889 person-years (py) of follow-up, corresponding to an incidence rate of 1.54 cases per 100 py (95%CI 1.33– 1.80). TB incidence in TST-positive patients who did not receive TLTBI was three times higher (6 cases/100 py) than in those who did (1.75 cases/100 py). In patients who received TLTBI, risk of development of TB was higher among cases aged <35 years (HR 6.14, 95%CI 1.12–33.73) and in those with a nadir CD4+ cell count of <200 cells/μl (HR 5.64, 95%CI 1.34–23.70). CONCLUS IONS : TLTBI is effective in preventing the development of TB in HIV-infected patients, particularly in those who were TST-positive.