Abstract
BACKGROUND: Tuberculosis preventive treatment (TPT) is critical to the End TB strategy. There is limited evidence on its long-term protective effect among people with human immunodeficiency virus (HIV) receiving antiretroviral therapy (ART) in high-burden programmatic settings. METHODS: This observational cohort study included people with HIV (PWH) who initiated a single TPT course from March 2017 to September 2018 at 14 ART centers in Andhra Pradesh, India (tuberculosis [TB] prevalence: 274/100 000). We followed PWH for 6 years and censored person-time at TB diagnosis, loss to follow-up, or death. We calculated TB incidence rates (IRs) and mortality rates (MRs) per 100 person-years (PY), stratified by TPT completion and effective ART (viral load <1000 copies/mL). Cox proportional hazards models estimated adjusted hazard ratios (aHRs) with 95% confidence limits (95% CL) for TB and mortality. RESULTS: We followed 4706 PWH for 23 414 PY. TB was diagnosed in 135 PWH (2.9%): 122 among 4454 PWH who completed TPT (IR, 0.55/100 PY [95% CL, .46-.66]) and 13 among 252 PWH who did not (IR, 1.06/100 PY [95% CL, .56-1.81]). There were 553 all-cause deaths (11.8%); the MR was 2.2/100 PY (95% CL, 2.0-2.4) among those who completed TPT compared to 13.5/100 PY (95% CL, 11.1-16.3) among those who did not. TPT, combined with effective ART, was associated with an 87% reduction in TB (aHR, 0.13 [95% CL, .05-.37]) and a 94% reduction in all-cause mortality (aHR, 0.06 [95% CL, .04-.10]). CONCLUSIONS: A single TPT course combined with effective ART conferred durable protection against TB and significantly reduced mortality among PWH in a high-TB-burden setting.