Tuberculosis after initiation of antiretroviral therapy in low-income and high-income countries

Abstract

We examined the incidence of and risk factors for tuber- culosis during the first year of highly active antiretroviral therapy in low-income (4540 patients) and high-income (22,217 patients) countries. Although incidence was much higher in low-income countries, the reduction in the inci- dence of tuberculosis associated with highly active antiret- roviral therapy was similar: the rate ratio for months 7–12 versus months 1–3 was 0.48 (95% confidence interval, 0.36– 0.64) in low-income countries and 0.36 (95% confidence in- terval, 0.26–0.50) in high-income countries. A low CD4 cell count at the start of therapy was the most important risk factor in both settings