---
title: "Tuberculosis Risk After TB Preventive Therapy in People with HIV Initiating ART"
id: "cdc-emerging-infectious-diseases-journal-5-tuberculosis-after-preventive-therapy-in-persons-living-with-hiv-initiating"
canonical_url: "https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-5-tuberculosis-after-preventive-therapy-in-persons-living-with-hiv-initiating"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "CDC Emerging Infectious Diseases Journal"
source_url: "https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article"
published_at: "2026-07-25T04:00:00.000Z"
evidence_level: "Agency Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Tuberculosis Risk After TB Preventive Therapy in People with HIV Initiating ART
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-5-tuberculosis-after-preventive-therapy-in-persons-living-with-hiv-initiating
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** CDC Emerging Infectious Diseases Journal
- **Source URL:** [Original Journal Publication](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article)
- **Published At:** 2026-07-25T04:00:00.000Z
- **Evidence Rating:** Agency Feed
## Executive GIST (TL;DR)
- Authors respond to comments noting their original study used routine programmatic data to describe **tuberculosis (TB)** risk after **TB preventive therapy (TPT)** among persons living with HIV who recently started antiretroviral therapy (**ART**). - The original analysis did not attempt to establish causality between TPT and subsequent TB disease; it was descriptive of observed TB incidence in program data. - The authors acknowledge that comparing groups by TPT completion can introduce **immortal time bias**, which may inflate the apparent protective association of TPT completion with lower TB incidence. - To address this, the dataset was re-analyzed with **TPT modeled as a time-varying exposure**, allowing person-time to be classified as not started, incomplete, or complete during follow-up. - After correction, adjusted incidence rate ratios (IRRs) were reduced but remained statistically significant and retained the same directionality as the initial results. - Reported revised effect estimates: compared with periods after TPT completion, TB incidence was higher during incomplete TPT (adjusted IRR 1.4, 95% CI 1.3–1.5) and higher among those who did not initiate TPT (adjusted IRR 2.2, 95% CI 1.9–2.5). - The authors interpret the smaller estimates as expected after bias correction and see the preserved pattern as reinforcing confidence in the original findings. - The letter emphasizes both the utility of routine programmatic data for assessing real-world TB risk and the need for appropriate analytic methods when interpreting such data. - Author team and affiliations are listed, including CDC staff in Maputo and Atlanta, US Agency for International Development in Maputo, and Mozambique Ministry of Health contributors. - References include the original dispatch and related literature on TB after TPT and methodological concerns in observational analyses.
## Clinical Analysis & Structured Key Points
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Any changes will be reflected in the online version in the month the article is officially released._ #### Volume 32, Number 8—August 2026 ##### _Letter_ ### Tuberculosis after Preventive Therapy in Persons Living with HIV Initiating Antiretroviral Therapy (Response) On This Page [Letter](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article) * * * [Cite This Article](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article) Downloads [Article ](https://wwwnc.cdc.gov/eid/article/32/8/pdfs/26-0828.pdf) * * * [RIS [TXT - 2 KB] ](https://wwwnc.cdc.gov/eid/article/32/8/26-0828.ris) Article Metrics [Metric Details](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article) Related Articles [Books and Media](https://wwwnc.cdc.gov/eid/article/32/8/26-0497_article) * * * [Tuberculosis after Preventive Therapy in Persons Living with HIV Initiating Antiretroviral Therapy](https://wwwnc.cdc.gov/eid/article/32/8/26-0493_article) * * * [Plausible Source Cases for _M. tuberculosis_](https://wwwnc.cdc.gov/eid/article/32/6/26-0104_article) * * * [More articles on Tuberculosis](https://wwwnc.cdc.gov/eid/spotlight/tuberculosis) [Cite This Article](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article "Show Article Citations") Open modal [Citation for Media](https://wwwnc.cdc.gov/eid/press) **In Response:** We appreciate Dr. Chen’s thoughtful comments (_1_) regarding our dispatch article ([_2_](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article#r1 "2")). In that analysis, we used routinely collected programmatic data to describe the risk of developing tuberculosis (TB) after TB preventive therapy (TPT) among persons living with HIV initiating antiretroviral therapy (ART) and did not aim to estimate a causal effect between TPT and TB. However, as Chen notes, comparisons on the basis of TPT completion are susceptible to immortal time bias and might overestimate the association between TPT exposure and TB incidence. That bias is a common gap in published literature on TB after TPT ([_3_](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article#r2 "3"),[_4_](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article#r3 "4")). To address that concern, we re-analyzed the data by treating TPT exposure as a time-varying variable, allowing person-time to be appropriately classified across not started, incomplete, and complete exposure states during follow-up. In that revised analysis, adjusted incidence rate ratios (IRRs) were somewhat smaller but remained statistically significant and followed the same pattern as the previous analysis. Compared with periods following TPT completion, TB incidence was higher during incomplete TPT (adjusted IRR 1.4, 95% CI 1.3–1.5) and among those who did not initiate TPT (adjusted IRR 2.2, 95% CI 1.9–2.5). The smaller effect estimates are consistent with what we would expect after correcting for this bias, and the fact that the overall pattern held reinforces confidence in the original findings. Our findings highlight both the value of routine programmatic data for understanding real-world TB risk and the importance of appropriate analytic approaches when interpreting such data. [TopExternal Link](javascript:void\(0\)) Lindsay Templin[![Comments to Author](https://wwwnc.cdc.gov/eid/content/images/icon/email.gif)](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article#comment) , Yagna Varajidas, Durval Respeito, Pereira Zindoga, Debora Weiss, Alexandre Nguimfack, Eudoxia Filipe, Arlete Mahumane, Maria Inês Tomo de Deus, José Mizela, Sonia Chilundo, Bruno Simoes, Aleny Couto, Ishani Pathmanathan, Emilio Dirlikov, and Benedita José Author affiliation: US Centers for Disease Control and Prevention, Maputo, Mozambique (L. Templin, Y. Varajidas, D. Respeito, A. Nguimfack, A. Mahumane, M. Tomo de Deus, J. Mizela, S. Chilundo, I. Pathmanathan, E. Dirlikov); US Agency for International Development, Maputo (P. Zindoga); Ministry of Health Mozambique, Maputo (E. Filipe, B. Simoes, A. Couto, B. José); US Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D. Weiss) [Top](javascript:void\(0\)) ### References 1. Templin L, Varajidas Y, Respeito D, Zindoga P, Weiss D, Nguimfack A, et al. Tuberculosis after TB preventive therapy in persons living with HIV recently initiating antiretroviral therapy, Mozambique. Emerg Infect Dis. 2026;32:409–13. [DOIExternal Link](https://doi.org/10.3201/eid3203.251349 "DOI")[PubMedExternal Link](https://pubmed.ncbi.nlm.nih.gov/41863538 "PubMed")[Google ScholarExternal Link](https://scholar.google.com/scholar_lookup?doi=10.3201%2feid3203.251349&pmid=41863538 "Google Scholar") 2. Turinawe G, Asaasira D, Kajumba MB, Mugumya I, Walusimbi D, Tebagalika FZ, et al. Active tuberculosis disease among people living with HIV on ART who completed tuberculosis preventive therapy at three public hospitals in Uganda. PLoS One. 2024;19:e0313284. [DOIExternal Link](https://doi.org/10.1371/journal.pone.0313284 "DOI")[PubMedExternal Link](https://pubmed.ncbi.nlm.nih.gov/39527556 "PubMed")[Google ScholarExternal Link](https://scholar.google.com/scholar_lookup?doi=10.1371%2fjournal.pone.0313284&pmid=39527556 "Google Scholar") 3. Agarwal R, Nyendak M, Chava N, Allam RR, Moonan PK, Sriram CS, et al. Long-term protection from tuberculosis preventive treatment among people with HIV in a high-burden tuberculosis setting: an observational cohort study from India. Clin Infect Dis. 2025;81:970–9. [DOIExternal Link](https://doi.org/10.1093/cid/ciaf322 "DOI")[PubMedExternal Link](https://pubmed.ncbi.nlm.nih.gov/40518945 "PubMed")[Google ScholarExternal Link](https://scholar.google.com/scholar_lookup?doi=10.1093%2fcid%2fciaf322&pmid=40518945 "Google Scholar") [Top](javascript:void\(0\)) [Cite This Article](https://wwwnc.cdc.gov/eid/article/32/8/26-0828_article "Show Article Citations") DOI: 10.3201/eid3208.260828 Original Publication Date: July 25, 2026 ##### Related Links * [More Letter Articles](https://wwwnc.cdc.gov/eid/articles/letters/volume-32) [Top](javascript:void\(0\)) [Table of Contents – Volume 32, Number 8—August 2026](https://wwwnc.cdc.gov/eid/articles/issue/32/8/table-of-contents) | EID Search Options | | --- | | ![presentation_01](https://wwwnc.cdc.gov/TemplatePackage/contrib/icons/standard/people_01.svg) [**Advanced Article Search**](https://wwwnc.cdc.gov/eid/AdvancedSearch) – Search articles by author and/or keyword. | | ![presentation_01](https://wwwnc.cdc.gov/TemplatePackage/contrib/icons/standard/map_01.svg) [**Articles by Country Search**](https://wwwnc.cdc.gov/eid/ArticleMap) – Search articles by the topic country. | | ![presentation_01](https://wwwnc.cdc.gov/TemplatePackage/contrib/icons/standard/search_01.svg) [**Article Type Search**](https://wwwnc.cdc.gov/eid/ArticleTypeSearch) – Search articles by article type and issue. | [Top](javascript:void\(0\)) Comments Please use the form below to submit correspondence to the authors or contact them at the following address: Lindsay Templin, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H21-10, Atlanta, GA 30329-4018, USA **Return Address** **Send To** Send To Authors Editors **Comments** _10000 character(s) remaining._ **Comment submitted successfully, thank you for your feedback.** **There was an unexpected error. 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> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.