Towards tuberculosis elimination in people with HIV on antiretroviral therapy: evidence from a two-decade nationwide cohort in Spain.

IF 5.5 1区医学

Infectious Diseases of Poverty Pub Date : 2026-03-06 DOI:10.1186/s40249-026-01426-9

Roser Navarro-Soler, Alfonso Muriel, Chiara Fanciulli, José I Bernardino, Carmen Sáez, Javier Zamora, Borja M Fernandez-Felix, Alejandro G García-Ruíz de Morales, Eva Poveda, Álvaro Mena de Cea, Javier Martínez-Sanz, Santiago Moreno, Sergio Serrano-Villar

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Abstract

Background: Tuberculosis (TB) incidence among people with HIV (PWH) has fallen in many high-income settings, yet residual risk persists, and tools to identify those still vulnerable are limited. This study aimed to evaluate TB incidence trends, identify risk factors, and develop a predictive score in PWH in Spain.

Methods: We conducted a retrospective nationwide cohort study using the Spanish AIDS Research Network (CoRIS). Adults initiating antiretroviral therapy (ART) between 2004 and 2023 were followed from ART start until incident TB, death, or censoring. Incidence rates were expressed per 1000 person-years; temporal trends were evaluated across four calendar periods. Independent risk factors were identified with multivariable Cox models, and a predictive score was internally validated with bootstrapping and ROC analysis.

Results: Among 16,476 PWH contributing 50,414 person-years, 61 developed TB, yielding an overall incidence of 1.21 cases/1000 person-years (95% CI 0.94-1.56). TB incidence rate declined by 97% between 2004-2008 and 2019-2023 (from 9.1 to 0.2 cases per 1000 person-years; IRR = 0.026, 95% CI 0.004-0.19). Injection-drug use (HR = 2.6, 95% CI 1.21-5.66), low educational attainment (HR = 2.8, 95% CI 1.05-7.51), baseline HIV-RNA viral load > 1 million copies/ml (HR = 1.7, 95% CI 1.00-2.82) and positive latent-TB infection (LTBI) screening (HR = 3.5, 95% CI 1.79-7.01) independently predicted incident TB. A four-variable model showed good discrimination (AUC = 0.71, 95% CI 0.65-0.77).

Conclusion: Universal ART and comprehensive LTBI management have driven a large decrease in TB incidence in Spanish PWH, but a small subset-characterised by social vulnerability, high viraemia and positive LTBI tests-remains at elevated risk. The validated risk score offers a pragmatic tool to target preventive therapy and surveillance where most needed in low-incidence, high-care settings.

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在接受抗逆转录病毒治疗的艾滋病毒感染者中实现消除结核病：来自西班牙20年全国队列的证据。

背景：在许多高收入环境中，艾滋病毒感染者（PWH）的结核病发病率已经下降，但剩余风险仍然存在，识别那些仍然脆弱的人的工具有限。本研究旨在评估西班牙PWH的结核病发病率趋势，确定危险因素，并制定预测评分。方法：我们利用西班牙艾滋病研究网络（CoRIS）进行了一项回顾性全国队列研究。2004年至2023年期间开始抗逆转录病毒治疗（ART）的成年人从ART开始一直随访到发生结核病、死亡或审查。发病率表示为每1000人年；对四个日历期间的时间趋势进行了评估。采用多变量Cox模型确定独立危险因素，并采用bootstrapping和ROC分析对预测评分进行内部验证。结果：在16476名PWH患者中，有50414人年，61人发展为结核病，总发病率为1.21例/1000人年（95% CI 0.94-1.56）。2004-2008年至2019-2023年期间，结核病发病率下降了97%（从每1000人年9.1例降至0.2例；IRR = 0.026, 95% CI 0.004-0.19）。注射药物使用（HR = 2.6, 95% CI 1.21-5.66）、低教育程度（HR = 2.8, 95% CI 1.05-7.51）、基线HIV-RNA病毒载量bbb100万拷贝/ml （HR = 1.7, 95% CI 1.00-2.82）和潜伏结核感染（LTBI）筛查阳性（HR = 3.5, 95% CI 1.79-7.01）独立预测结核病的发生。四变量模型具有良好的判别性（AUC = 0.71, 95% CI 0.65-0.77）。结论：普遍的抗逆转录病毒治疗和全面的LTBI管理推动了西班牙PWH结核病发病率的大幅下降，但一小部分人群——以社会脆弱性、高病毒血症和LTBI检测阳性为特征——仍处于高风险状态。经过验证的风险评分提供了一种实用的工具，可以针对低发病率、高护理环境中最需要的预防治疗和监测。

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来源期刊

Infectious Diseases of Poverty INFECTIOUS DISEASES-

自引率

1.20%

发文量

368

期刊介绍： Infectious Diseases of Poverty is an open access, peer-reviewed journal that focuses on addressing essential public health questions related to infectious diseases of poverty. The journal covers a wide range of topics including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. It also considers the transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology. The journal aims to identify and assess research and information gaps that hinder progress towards new interventions for public health problems in the developing world. Additionally, it provides a platform for discussing these issues to advance research and evidence building for improved public health interventions in poor settings.