Risk of Tuberculosis after Antiretroviral Treatment Initiation: A Comparison between Efavirenz and Nevirapine Using Inverse Probability Weighting. Issue 4 (May 2013)

• Record Type: Journal Article
• Authors: Hermans, Sabine M; Manabe, Yukari C; Kiragga, Agnes N; Hoepelman, Andy IM; Lange, Joep MA; Van Leth, Frank
• Is Part Of: Antiviral therapy. Volume 18:Issue 4(2013)
• Page Start: 1
• Page End: 8
• Publication Date: 2013-05
• Subjects: Antiviral agents -- Periodicals; Antiviral Agents -- therapeutic use; Virus Diseases -- therapy; Viruses -- drug effects; Antiviral agents; Periodical; Electronic journals; Periodicals; 616.9106
• DOI: 10.3851/IMP2525
• Languages: English
• ISSNs: 1359-6535

Abstract

Background: There is a high incidence of tuberculosis (TB) early after antiretroviral therapy (ART) initiation. This historical cohort study evaluated the association of efavirenz (EFV) compared to nevirapine (NVP) with post-ART TB among patients initiated on first-line ART from 2005 to 2009 in a large, urban HIV clinic in Uganda. Methods: Hazard ratios (HR) for developing TB were computed using multivariable Cox proportional hazards models with inverse weighting of the probability of being prescribed NVP or EFV (calculated by a multi-variable logistic regression model), stratifying by baseline CD4 + T-cell count. Adjustment for time-updated CD4 + T-cell count, restriction of the analysis to patients remaining in follow-up and a TB-free survival analysis were performed as sensitivity analyses. Results: ART was initiated in 5, 797 patients; 66% were women with a mean age of 37 years (sd 9) and a median baseline CD4 + T-cell count of 117 cells/mm 3 (IQR 43–182). Overall, 60% ( n =3, 484) were initiated on NVP and 40% ( n =2, 313) on EFV. In the first 2 years of ART, 377 patients developed TB. The use of EFV compared to NVP was independently associated with higher TB incidence in patients with a baseline CD4 + T-cell count <100 cells/mm 3 (HR 2.05 [95% CI 1.29, 3.27]; P =0.003), but not at higher CD4 + T-cell counts (HR 0.71 [95% CI 0.39, 1.31]; P =0.428). These estimates were robust to all sensitivity analyses. Conclusions: There was a higher incidence of TB in patients with baseline CD4 + T-cell counts <100 cells/mm 3 initiated on EFV compared to those initiated on NVP. Further research in a trial setting or a larger multisite observational cohort is needed to confirm these findings.