B Tchakounte Youngui 1 P Coffie 2 E Messou 3 A Poda 4 L Fortes Déguénonvo 5 D Hawerlander 6 A Minga 7 E Balestre 8 F Dabis 9 O Marcy 9 1 ISPED ID: 625151
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Slide1
Incidence of tuberculosis in the first year of antiretroviral treatment in West-African HIV-infected adults
B. Tchakounte Youngui1, P. Coffie2, E. Messou3, A. Poda4, L. Fortes Déguénonvo5, D. Hawerlander6, A. Minga7, E. Balestre8, F. Dabis9, O. Marcy9(1) ISPED, University of Bordeaux, France, (2) Programme PACCI, Site ANRS, Abidjan, Côte D'Ivoire, (3) CePReF-Aconda-VS, Abidjan, Côte D'Ivoire, (4) CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso, (5) CHNU Fann, Dakar, Senegal, (6) CIRBA, Abidjan, Côte D'Ivoire, (7) CNTS/PRIMO-CI, Abidjan, Côte D'Ivoire, (8) INSERM U897, ISPED, University of Bordeaux, France, (9) INSERM U1219, University of Bordeaux, France
Paris
July 24
th
2017Slide2
Conflict of Interest
“No conflicts of interest to declare”.Slide3
Background
HIV prevalence |2015 36.7 million worlwide / 25.5 million (69.9%) in Sub-Saharan Africa TB burden in PLHIV |2015 1.17 million cases worlwide /834,000 (71.3%) in Africa390,000 deaths worlwide/ 300,000 (76.9%) in AfricaTB incidence in PLHIV
Improved access to antiretroviral therapy (ART) ⇒ reduction of TB incidenceremains higher in PLHIV on ART than in non-infected persons
TB prevention in PLHIVIsoniazid
preventive therapy (IPT)
recommended
, not
implemented
in West
Africa
UNAIDS Data, WHO Global TB report 2016,
Duda et al 2010 (
IeDEA
) Slide4
Background and Objective
Objective Assess tuberculosis incidence during the first year of antiretroviral therapy and identify associated factors in HIV-infected adults in West AfricaSlide5
Methods:
Study design and populationIeDEA West African collaboration cohort3 HIV outpatient centers in Côte d'Ivoire (Abidjan), Burkina Faso (Bobo Dioulasso), and Senegal (Dakar)Inclusion criteriaHIV-infected adults (≥16 years) initiating ART between 2010 and 2014Without ongoing TB at ART initiation≥1 follow-up visitPatient follow-upUsual site visit calendarsNo IPTSlide6
Methods:
Study design and populationTB diagnosisSystematic symptom screening for active TBAccording to national recommendationsSputum microscopy and chest radiographyXpert perfom if smear negative (since 2013)Endpoint: incident TB defined as first TB event notified > 1 week and ≤ 1 year on ART
Statistics: Crude incidence
Adjusted incidence and associated
factors identified by
multivariate
Poisson
regression
modelsSlide7
Results
4,154 started ART since 2010 in the 3 sites3,404 on ART with ≥ 1 follow-up visit
750
without follow-up visit after
ART initiation
3,213
included in our analysis
191
patients
with ongoing TB at initiation of ART.
170
incident TB casesSlide8
Results
– Patients characteristics N
n or median
% or IQR
Country
3213
Côte
d’Ivoire (CI)
959
29.8
Burkina Faso (BF)
1863
58.0
Senegal
(SN)
391
12.2
Age (
years
)
3192
38.5
32.0 – 45.4
Sex
female
3210
2153
67.1
BMI (kg/m
2
)
3064
20.6
18.0 – 24.0
Past
TB
history
2559
176
6.9
CD4 cell count (cells/µl)
3067
211
95 – 343
Hemoglobin
level
(g/dl)
3063
11.0
9.4 – 12.2Slide9
Results - TB
incidence density rate Period at risk (years), median (IQR)
No. at risk
PY at risk
TB cases
Crude incidence rate /100 PY (95%CI)
CI
1.00 (0.51 – 1.00)
959
744.7
106
14.23 (11.52–16.94)
BF
1.00 (0.37 – 1.00)
1863
1334.0
59
4.42 (3.29–5.55)
SN
0.99 (0.46 – 1.00)
391
281.8
5
1.77 (0.22–3.33)
ALL
1.00 (0.44 – 1.00)
3213
2360.5
170
7.2 (6.12–8.28)Slide10
Results -
TB incidence and associated factorsSlide11
Discussion
Overall TB incidence rate is 20 times higher than the incidence of TB in the general population of the 3 countries.Associated factors: sex, CD4, Hb level, past history of TB strongly associated with the incidence of TB on ART: similar result found by Seyler et al. In 2005 in Abidjan.Adjusted incidence 4 times higher in patients from CI in line with incidence rates in the general population:BF: 54 [48 – 59] cases / 100,000 PYCI: 165 [150 – 179] cases / 100,000 PYSN: 138 [122 – 154] cases / 100,000 PYSlide12
Conclusion
Tuberculosis incidence remains high during the first year on ART in the West African context in the absence of IPT Several studies demonstrate the efficacity of combining ART and IPT in reducing of tuberculosis incidence and mortality in PLHIVImplementation of IPT is necessary in PLHIV in West African settings despite lower incidence rates in the general population compared to Eastern or Southern AfricaTemprano Anrs Study Group, 2015Slide13
Acknowledgments
All the team of IeDEA West Africa
Regional Office (PAC-CI, Abidjan, Côte d’Ivoire)IeDEA West Africa participating
sites:Burkina Faso , Bobo Dioulasso: Jacques Zoungrana, Ibrahim Soré, Achille Tapsoba (CHU
Souro Sanou)Côte d’Ivoire, Abidjan: Henri Chenal, Magloire Moh (CIRBA), Joachim Charles
Gnokoro
, Koffi Ladji Issouf (ACONDA-
CePReF
), Yao Abo, Jean Michel
Yoboue (CMSDS/CNTS)Senegal, Dakar: Moussa Seydi
,
Judicael
Malick Tine(SMIT, CHU
Fann
)Slide14
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