Incident tuberculosis in people with HIV across Europe from 2012-2022: incidence rates, risk factors, and regional differences in a multicentre cohort study.

Background: Tuberculosis remains the leading cause of death among people with HIV. The aim of this study was to describe the incidence of tuberculosis (TB), explore risk factors and to calculate their population attributable fractions (PAF) in people with HIV across Europe, stratified by region.

Method: Longitudinal study of people with HIV aged>18 years with follow-up from either 1/1/2012, or cohort enrolment, until date of TB diagnosis, last visit, death, or 31/12/2022. Factors associated with TB, in particular antiretroviral therapy status and smoking, were analysed using multivariable Poisson regression.

Results: A total of 38 837 participants with HIV with a median follow-up of 7.7 (4.3-10.4) years. Overall, 306 TB cases were diagnosed during 275 811 person-years of follow-up (PYFU; incidence rate (IR) 1.03/1000 PYFU, 95% CI 0.91-1.11). 3.3% (n=81/2428) participants had incident TB in Eastern Europe (IR 6.13, 4.93-7.62). Overall, the IR decreased from 2.03 (1.53-2.68) in 2012 to 0.44 (0.20-0.97) in 2022. Modifiable risk factors were smoking (adjusted incidence rate ratio 2.94; 95%CI1.62-5.34) and not receiving antiretroviral therapy (versus on; 3.29; 2.36-4.58). A history of TB pre-baseline increased the risk of recurrence (aIRR 7.77; 95%CI 4.09-14.74). The PAF for not receiving antiretroviral therapy was 34.6% in Non-Eastern Europe and 31.2% in Eastern Europe.

Conclusions: TB incidence has been decreasing among people with HIV, but remains more frequent in Eastern Europe. Improvement of antiretroviral therapy-coverage and adherence and a focus on non-communicable disease risk factors such as smoking could reduce the incidence of TB.