IAS 2017 IASconference Incidence of tuberculosis in the

#IAS 2017 | @IAS_conference Incidence of tuberculosis in the first year of antiretroviral treatment in West-African HIV -infected adults B. Tchakounte Youngui , P. Coffie , E. Messou , A. Poda , L. Fortes 1 2 3 4 Déguénonvo 5, D. Hawerlander 6, A. Minga 7, E. Balestre 8, F. Dabis 9, O. Marcy 9 (1) ISPED, University of Bordeaux, France, (2) Programme PACCI, Site ANRS, Abidjan, Côte D'Ivoire, (3) Ce. PRe. F-Aconda-VS, Abidjan, Côte D'Ivoire, (4) CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso, (5) CHNU Fann, Dakar, Senegal, (6) CIRBA, Abidjan, Côte D'Ivoire, (7) CNTS/PRIMO-CI, Abidjan, Côte D'Ivoire, (8) INSERM U 897, ISPED, University of Bordeaux, France, (9) INSERM U 1219, University of Bordeaux, France Paris July 24 th 2017

#IAS 2017 | @IAS_conference Conflict of Interest “No conflicts of interest to declare”.

Background § HIV prevalence |2015 o 36. 7 million worlwide / 25. 5 million (69. 9%) in Sub-Saharan Africa § TB burden in PLHIV |2015 o 1. 17 million cases worlwide /834, 000 (71. 3%) in Africa o 390, 000 deaths worlwide/ 300, 000 (76. 9%) in Africa § TB incidence in PLHIV o Improved access to antiretroviral therapy (ART) ⇒ reduction of TB incidence o remains higher in PLHIV on ART than in non-infected persons § TB prevention in PLHIV o Isoniazid preventive therapy (IPT) recommended, not implemented in West Africa UNAIDS Data, WHO Global TB report 2016, Duda et al 2010 (Ie. DEA)

Background and Objective § Objective ↳ Assess tuberculosis incidence during the first year of antiretroviral therapy and identify associated factors in HIVinfected adults in West Africa

Methods: Study design and population § Ie. DEA West African collaboration cohort § 3 HIV outpatient centers in Côte d'Ivoire (Abidjan), Burkina Faso (Bobo Dioulasso), and Senegal (Dakar) § Inclusion criteria ↳ HIV-infected adults (≥ 16 years) ↳ initiating ART between 2010 and 2014 ↳ Without ongoing TB at ART initiation ↳ ≥ 1 follow-up visit § Patient follow-up ↳ Usual site visit calendars ↳ No IPT

Methods: Study design and population § TB diagnosis ↳ Systematic symptom screening for active TB ↳ According to national recommendations ↳ Sputum microscopy and chest radiography ↳ Xpert perfom if smear negative (since 2013) § Endpoint: incident TB defined as first TB event notified > 1 week and ≤ 1 year on ART § Statistics: ↳ Crude incidence ↳ Adjusted incidence and associated factors identified by multivariate Poisson regression models

Results 4, 154 started ART since 2010 in the 3 sites 750 without follow-up visit after ART initiation 3, 404 on ART with ≥ 1 follow -up visit 3, 213 included in our analysis 170 incident TB cases 191 patients with ongoing TB at initiation of ART.

Results – Patients characteristics Country Côte d’Ivoire (CI) Burkina Faso (BF) Senegal (SN) N 3213 Age (years) n or median 959 1863 391 % or IQR 29. 8 58. 0 12. 2 3192 38. 5 32. 0 – 45. 4 Sex female 3210 2153 67. 1 BMI (kg/m 2) 3064 20. 6 18. 0 – 24. 0 Past TB history 2559 176 6. 9 CD 4 cell count (cells/µl) 3067 211 95 – 343 Hemoglobin level (g/dl) 3063 11. 0 9. 4 – 12. 2

Results - TB incidence density rate Period at risk (years), median (IQR) TB Crude incidence No. at PY at case rate /100 PY risk s (95%CI) CI 1. 00 (0. 51 – 1. 00) 959 744. 7 106 14. 23 (11. 52– 16. 94) BF 1334. 1. 00 (0. 37 – 1. 00) 1863 0 59 4. 42 (3. 29– 5. 55) SN 0. 99 (0. 46 – 1. 00) 391 281. 8 5 1. 77 (0. 22– 3. 33) ALL 2360. 1. 00 (0. 44 – 1. 00) 3213 5 170 7. 2 (6. 12– 8. 28)

Results - TB incidence and associated factors

Discussion § Overall TB incidence rate is 20 times higher than the incidence of TB in the general population of the 3 countries. § Associated factors: sex, CD 4, Hb level, past history of TB strongly associated with the incidence of TB on ART: similar result found by Seyler et al. In 2005 in Abidjan. § Adjusted incidence 4 times higher in patients from CI in line with incidence rates in the general population: ↳ BF: 54 [48 – 59] cases / 100, 000 PY ↳ CI: 165 [150 – 179] cases / 100, 000 PY

Conclusion § Tuberculosis incidence remains high during the first year on ART in the West African context in the absence of IPT § Several studies demonstrate the efficacity of combining ART and IPT in reducing of tuberculosis incidence and mortality in PLHIV § Implementation of IPT is necessary in PLHIV in West African settings despite lower incidence rates in the general population compared to Eastern or Temprano Anrs Study Group, 2015 Southern Africa

Acknowledgments § All the team of Ie. DEA West Africa Regional Office (PAC-CI, Abidjan, Côte d’Ivoire) § Ie. DEA West Africa participating sites: § Burkina Faso , Bobo Dioulasso: Jacques Zoungrana, Ibrahim Soré, Achille Tapsoba (CHU Souro Sanou) § Côte d’Ivoire, Abidjan: Henri Chenal, Magloire Moh (CIRBA), Joachim Charles Gnokoro, Koffi Ladji Issouf (ACONDACe. PRe. F), Yao Abo, Jean Michel Yoboue

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