Tuberculosis incidence among people living with HIV in Israel: a 42-year follow-up study

OBJECTIVES: People living with HIV (PLHIV) who are coinfected with tuberculosis are at risk for negative health outcomes. This study describes the tuberculosis incidence in Israel and identifies high-risk groups. METHODS: This 42-year study includes all tuberculosis cases reported in Israel after HIV diagnosis. Fine-Gray models were adjusted to three timeframes, according to the availability of antiretroviral treatment (ART): 1981-1996 (pre-ART), 1997-2016 (ART), 2017-2023 (immediate ART upon detection). RESULTS: Of all 12,004 PLHIV, 413 (3.4%) developed tuberculosis: 132 (7.4%) between 1981 and 1996; 263 (3.6%) between 1997 and 2016; and 18 (0.6%) between 2017 and 2023, P <0.001. Non-Israeli-born citizen PLHIV were at higher risk for developing tuberculosis than Israeli-born citizens (0.5 vs 0.05 per 100 person-years, respectively; P <0.001). Risk factors for developing tuberculosis among 6933 Israeli PLHIV included being heterosexual, originating from endemic countries (hazard ratio [HR] 17.8, 95% confidence interval [CI]: 9.7-32.6, P <0.01), intravenous drug users (HR = 12.9, 95% CI: 6.8-24.5, P <0.01), and being diagnosed with HIV in 1981-1996 and 1997-2016 (HR = 5.6, 95% CI: 2.3-13.9, P <0.01 and HR = 2.5, 95% CI: 1.0-6.0, P = 0.05, respectively). CONCLUSIONS: Tuberculosis incidence among PLHIV was highest among migrants from endemic countries and intravenous drug users. Tuberculosis incidence declined after the introduction of ART and was further reduced when ART was provided immediately upon detection.