Background In countries with low tuberculosis burden, the risk of tuberculosis in people living with human immunodeficiency virus (HIV; PWH) once HIV virological suppression is achieved is not fully understood. Methods In a nationwide cohort, we included all adult PWH from the Danish HIV Cohort initiating antiretroviral therapy (ART) (1995–2017) without prior tuberculosis disease. We used Kaplan–Meier estimation and Poisson regression to calculate the tuberculosis incidence rate (IR) after 6 months of ART, along with associated risk factors and mortality rates. Results Among 6849 PWH initiating ART (median follow-up, 7.4 years), 84 developed tuberculosis (IR, 1.4/1000 person-years [PY]), 54 of them >6 months after ART initiation (IR, 0.97/1000 PY [95% confidence interval [CI]: 1.17–1.79); 1.95/1000 PY [1.34–2.76] in non–Danish born, 0.36/1000 PY [.21–.62] in Danish born without injection drug use (IDU), and 2.95/1000 PY [1.53–5.66] in Danish born with IDU). Danish-born individuals with suppressed viremia and no IDU or known tuberculosis exposures had the lowest risk (IR, 0.05/1000 PY). In the adjusted analysis, being non–Danish born (adjusted IR ratio, 4.27 [95% CI: 2.36–7.72]), IDU (4.95 [2.55–9.62]), and previous AIDS-defining events (2.05 [1.06–3.94]) raised the tuberculosis risk, while suppressed HIV RNA levels (0.58 [.34–.99]) reduced it. The overall mortality rate for HIV/tuberculosis coinfected after ART was high, at 48.9/1000 PY (95% CI: 30.4–78.7). Conclusions The tuberculosis risk remains elevated in PWH beyond 6 months after ART initiation, especially among migrants, those with IDU, those without suppressed HIV RNA, and those exposed to areas highly endemic for tuberculosis or with social risk determinants of health. Conversely, PWH without these risk factors have a tuberculosis risk similar to the general population and would not require targeted tuberculosis screening strategies.

中文翻译：

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抗逆转录病毒治疗实现人类免疫缺陷病毒病毒学抑制后发生结核病的风险：一项丹麦全国前瞻性队列研究


背景 在结核病负担较低的国家，人类免疫缺陷病毒 （HIV;PWH） 尚未完全清楚。方法 在全国队列中，我们纳入了来自丹麦 HIV 队列中开始抗逆转录病毒治疗 （ART） （1995-2017） 且既往无结核病的所有成年 PWH。我们使用 Kaplan-Meier 估计和泊松回归来计算 ART 6 个月后的结核病发病率 （IR），以及相关的危险因素和死亡率。结果 在 6849 例开始 ART 的 PWH 中（中位随访，7.4 年），84 例发展为肺结核（IR，1.4/1000 人年 [PY]），其中 54 例在 ART 开始后 >6 个月（IR，0.97/1000 PY [95% 置信区间 [CI]：1.17-1.79）;非丹麦出生者为 1.95/1000 PY [1.34-2.76]，丹麦出生时未注射吸毒 （IDU） 为 0.36/1000 PY [.21-.62]，丹麦出生时患有 IDU 的 2.95/1000 PY [1.53-5.66]）。病毒血症受到抑制且无 IDU 或已知结核病暴露的丹麦出生个体风险最低 （IR，0.05/1000 PY）。在调整后的分析中，非丹麦出生（调整后的 IR 比率，4.27 [95% CI： 2.36–7.72]）、IDU （4.95 [2.55–9.62]）和既往艾滋病定义事件 （2.05 [1.06–3.94]） 增加了结核病风险，而抑制的 HIV RNA 水平 （0.58 [.34–.99]） 降低了结核病风险。ART 后 HIV/结核病合并感染的总体死亡率很高，为 48.9/1000 PY（95% CI：30.4-78.7）。结论 ART 开始后 6 个月后，PWH 的结核病风险仍然升高，尤其是在移民、IDU 患者、HIV RNA 未抑制者以及暴露于结核病高度流行地区或具有健康社会风险决定因素的人中。 相反，没有这些风险因素的 PWH 具有与一般人群相似的结核病风险，不需要有针对性的结核病筛查策略。