{"doi":"10.17615/eq25-dd10","title":"Timing of antiretroviral treatment, immunovirologic status, and TB risk: Implications for testing and treatment","abstract":"Background: Tuberculosis (TB) risk and mortality increase in the 6 months after highly active antiretroviral therapy (HAART) initiation. This short-term risk may be a consequence of HAART initiation and immune reconstitution. Alternatively, it may be due to confounding by low CD4+ counts and high HIV viral loads (VLs). We assessed the TB risk before and after HAART initiation while appropriately controlling for time-updated laboratory values and HAART exposure. Methods: We conducted an observational cohort study among persons enrolled in the North American AIDS Cohort Collaboration on Research and Design from 1998 through 2011. A marginal structural model was constructed to estimate the association of HAART initiation and TB risk. Inverse probability weights for the probability of HAART initiation were incorporated. Results: Among 26,342 patients, 94 cases of TB were diagnosed during 147,557 person-years (p-y) of follow-up. The unadjusted TB rates were 93/100,000 p-y [95% confidence interval (CI): 63 to 132] before HAART initiation, 203/100,000 p-y (95% CI: 126 to 311) ≤6 months after HAART initiation, and 40/100,000 p-y (95% CI: 29 to 55) >6 months on HAART. After controlling for time-updated laboratory values, the adjusted odds of TB ≤6 months after HAART initiation and >6 months was 0.65 (95% CI: 0.28 to 1.51) and 0.29 (95% CI: 0.16 to 0.53), respectively. Conclusions: TB risk in the first 6 months after HAART initiation is not higher than that before HAART initiation after adjusting for CD4+ count and VLs. These findings suggest that short-term TB risk may be related to low CD4+ counts and high VLs near HAART initiation and support early HAART initiation to decrease TB risk.","journal":"UNC Libraries","year":2024,"id":499360,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9618,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":240238,"name":"Cathy A. Jenkins","orcid":"0000-0001-7217-2985","position":1,"is_corresponding":false},{"id":1345659,"name":"B.E Shepherd","orcid":null,"position":2,"is_corresponding":false},{"id":1347372,"name":"Ana Micaelle da Silva Mendes","orcid":"0000-0002-4378-6811","position":3,"is_corresponding":false},{"id":926745,"name":"Richard W. Moore","orcid":"0000-0002-8865-6746","position":4,"is_corresponding":false},{"id":1347865,"name":"Arthur M. Freeman","orcid":null,"position":5,"is_corresponding":false},{"id":346880,"name":"April C. Pettit","orcid":"0000-0001-8832-0866","position":6,"is_corresponding":false},{"id":1345329,"name":"Trinity Sterling","orcid":"0009-0006-4639-6217","position":7,"is_corresponding":false},{"id":340146,"name":"Sonia Napravnik","orcid":"0000-0002-9032-3713","position":8,"is_corresponding":false},{"id":240244,"name":"M. John Gill","orcid":"0000-0002-8546-8790","position":9,"is_corresponding":false},{"id":394343,"name":"Anita Rachlis","orcid":null,"position":10,"is_corresponding":false},{"id":315468,"name":"David W. Dowdy","orcid":"0000-0003-0481-7475","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T02:09:53.188165Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}