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Volume 32, Number 8—August 2026
Letter
Tuberculosis after Preventive Therapy in Persons Living with HIV Initiating Antiretroviral Therapy (Response)
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Citation for Media
In Response: We appreciate Dr. Chen’s thoughtful comments (1) regarding our dispatch article (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 (3,4).
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.
, 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
References
- 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. DOIPubMedGoogle Scholar
- 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 . DOIPubMedGoogle Scholar - 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. DOIPubMedGoogle Scholar
Original Publication Date: July 25, 2026
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Table of Contents – Volume 32, Number 8—August 2026
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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
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