Objectives

To explore changes over time in the epidemiology of tuberculosis (TB) in Denmark in people living with human immunodeficiency virus (HIV) (PLWH).

Methods

In this nationwide, population-based cohort study we included all adult PLWH from the Danish HIV Cohort Study (1995–2017) without previous TB. We estimated TB incidence rate (IR), all-cause mortality rate (MR), associated risk and prognostic factors using Poisson regression.

Results

Among 6982 PLWH (73 596 person-years (PY)), we observed 217 TB events (IR 2.9/1000 PY, 95% CI 2.6–3.4: IR 6.7, 95% CI 5.7–7.9 among migrants and IR 1.4, 95% CI 1.1–1.7 among Danish-born individuals; p < 0.001). The IR of concomitant HIV/TB remained high and unchanged over time. The IR of TB diagnosed >3 months after HIV diagnosis declined with calendar time, longer time from HIV diagnosis, and CD4 cell recovery. Independent TB risk factors were African/Asian/Greenland origin (adjusted incidence rate ratio (aIRR) 5.2, 95% CI 3.5–7.6, aIRR 6.5, 95% CI 4.2–10.0, aIRR 7.0, 95% CI 3.4–14.6, respectively), illicit drug use (aIRR 6.9, 95% CI 4.2–11.2), CD4 <200 cells/μL (aIRR 2.7, 95% CI 2.0–3.6) and not receiving antiretroviral therapy (aIRR 3.7, 95% CI 2.5–5.3). Fifty-five patients died (MR 27.9/1000 PY, 95% CI 21.4–36.3), with no improvement in mortality over time. Mortality prognostic factors were Danish-origin (adjusted mortality rate ratio (aMRR) 2.3, 95% CI 1.3–4.3), social burden (aMRR 3.9, 95% CI 2.2–7.0), CD4 <100 cells/μL at TB diagnosis (aMRR 2.6, 95% CI 1.3–4.9), TB diagnosed >3 months after HIV versus concomitant diagnosis (aMRR 4.3, 95% CI 2.2–8.7) and disseminated TB (aMRR 3.3, 95% CI 1.1–9.9).

Conclusion

Late HIV presentation with concomitant TB remains a challenge. Declining TB rates in PLWH were observed over time and with CD4 recovery, highlighting the importance of early and successful antiretroviral therapy. However, MR remained high. Our findings highlight the importance of HIV and TB screening strategies and treatment of latent TB in high-risk groups.

中文翻译：

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人类免疫缺陷病毒感染者的结核病发病率和死亡率：丹麦全国队列研究

目标

探讨丹麦人类免疫缺陷病毒 (HIV) (PLWH) 人群中结核病 (TB) 流行病学随时间的变化。

方法

在这项全国性的、基于人群的队列研究中，我们纳入了来自丹麦 HIV 队列研究（1995-2017 年）的所有成人 PLWH，没有既往结核病史。我们使用泊松回归估计了结核病发病率 (IR)、全因死亡率 (MR)、相关风险和预后因素。

结果

在 6982 名 PLWH（73 596 人年 (PY)）中，我们观察到 217 起 TB 事件（IR 2.9/1000 PY，95% CI 2.6-3.4：IR 6.7，95% CI 5.7-7.9 在移民中，IR 1.4，95%丹麦出生个体的 CI 1.1–1.7；p < 0.001)。伴随 HIV/TB 的 IR 仍然很高，并且随着时间的推移没有变化。在 HIV 诊断后 3 个月以上诊断出的 TB 的 IR 随着日历时间、从 HIV 诊断时间延长和 CD4 细胞恢复而下降。独立的结核病危险因素是非洲/亚洲/格陵兰起源（调整后发病率比 (aIRR) 5.2、95% CI 3.5-7.6、aIRR 6.5、95% CI 4.2-10.0、aIRR 7.0、95% CI 3.4-14.6） , 非法药物使用 (aIRR 6.9, 95% CI 4.2–11.2), CD4 <200 个细胞/μL (aIRR 2.7, 95% CI 2.0–3.6) 且未接受抗逆转录病毒治疗 (aIRR 3.7, 95% CI 2.5–5.3)。55 名患者死亡（MR 27.9/1000 PY，95% CI 21.4–36.3），随着时间的推移死亡率没有改善。死亡率预后因素是丹麦血统（调整后的死亡率比 (aMRR) 2.3, 95% CI 1.3-4.3），社会负担（aMRR 3.9, 95% CI 2.2-7.0），结核病诊断时 CD4 <100 个细胞/μL（aMRR 2.6, 95% CI 1.3–4.9)，在 HIV 与伴随诊断 (aMRR 4.3, 95% CI 2.2–8.7) 和播散性结核病 (aMRR 3.3, 95% CI 1.1–9.9) 后 > 3 个月诊断出结核病。

结论

伴随结核病的晚期 HIV 表现仍然是一个挑战。随着时间的推移和 CD4 的恢复，PLWH 的结核病发病率下降，这突出了早期和成功的抗逆转录病毒治疗的重要性。然而，MR仍然很高。我们的研究结果强调了高危人群中 HIV 和 TB 筛查策略和潜伏性 TB 治疗的重要性。