Incidence of tuberculosis in HIV-infected adults on first- And second-line antiretroviral therapy in India

Akshay N. Gupte, Dileep Kadam, Shashikala Sangle, Bharat B. Rewari, Sonali Salvi, Amol Chavan, Smita Nimkar, Jonathan Golub, Nikhil Gupte, Amita Gupta, Ivan Marbaniang, Vidya Mave

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2 Scopus citations


Background: Programmatic data on the baseline risk of tuberculosis in people living with HIV (PLHIV) are needed to evaluate long-term effectiveness of the ongoing isoniazid preventive therapy (IPT) roll-out in India. Methods: We estimated the incidence rate and risk factors of tuberculosis disease in adult PLHIV initiating first- and second-line anti-retroviral therapy (ART) prior to widespread IPT in a public ART center in Pune, India. Results: 4067 participants contributing 5205.7 person-years of follow-up on first-line ART and 871 participants contributing 1031.7 person-years of follow-up on second-line ART were included in the analysis. The incidence rate of tuberculosis was 4.39 cases (95%CI 3.86-5.00) per 100 person-years on first-line ART and 1.64 cases (95%CI 1.01-2.63) per 100 person-years on second-line ART (p < 0.001). After adjusting for competing risks, male sex (aSHR = 1.33, 95%CI 1.02-1.74, p = 0.03), urban residence (aSHR = 1.53, 95%CI 1.13-2.07, p = 0.006) and CD4+ counts < 350 cells/mm3 (aSHR = 3.06 vs CD4 > 350 cells/mm3, 95%CI 1.58-5.94, p < 0.001) at ART initiation were associated with higher risk of tuberculosis independent of ART regimen. Conclusion: Risk of tuberculosis was lower in PLHIV receiving second-line ART compared to first-line ART. Prioritizing IPT in PLHIV with low CD4+ counts, urban residence and in males may further mitigate the risk of tuberculosis during ART.

Original languageEnglish (US)
Article number914
JournalBMC infectious diseases
Issue number1
StatePublished - Oct 29 2019


  • Competing risks
  • HIV
  • India
  • Second-line ART
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases


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