Incidence, risk factors and mortality of tuberculosis in Danish HIV patients 1995-2007

We included patients from a population-based, multicenter, nationwide cohort. We calculated incidence rates (IRs) and mortality rates (MRs). Cox's regression analysis was used to estimate risk factors for TB infection with HAART initiation included as time updated variable. Kaplan-Meier was used to estimate mortality after TB.Among 2,668 patients identified, 120 patients developed TB during the follow-up period. The overall IR was 8.2 cases of TB/1,000 person-years of follow-up (PYR). IRs decreased during the pre-, early and late-HAART periods (37.1/1000 PYR, 12.9/1000 PYR and 6.5/1000 PYR respectively). African and Asian origin, low CD4 cell count and heterosexual and injection drug user route of HIV transmission were risk factors for TB and start of HAART reduced the risk substantially. The overall MR in TB patients was 34.4 deaths per 1,000 PYR (95% Confidence Interval: 22.0-54.0) and was highest in the first two years after the diagnosis of TB.Incidence of TB still associated with conventional risk factors as country of birth, low CD4 count and route of HIV infection while HAART reduces the risk substantially. The mortality in this patient population is high in the first two years after TB diagnosis.The prognosis for Human Immunodeficiency Virus (HIV) infected patients has changed dramatically after the introduction of Highly Active Antiretroviral Therapy (HAART) [1]. In spite of the effect of HAART, tuberculosis (TB) is still one of the most frequently acquired immune-deficiency syndrome (AIDS) defining conditions worldwide [2]. Though effective, prevention of TB in HIV positive by tuberculin skin testing and targeted preventive treatments is of limited clinical success [3,4]. In contrast, implementation of HAART has been the best preventive measure and incidence rates of TB co-infection have from Western World settings been reported to decrease from the pre- to late-HAART period. A European study reported incidence rates before September 1995 of 0.8/100 person