HIV-1 Infection as a Risk Factor for the Development of Tuberculosis: A Case-Control Study in Tanzania

Abstract

A population-based case-control study was carried out in Mwanza Region, Tanzania, to determine the relative and population attributable risk of human immunodeficiency virus type 1 (HIV-1) infection for developing active tuberculosis. Cases were 441 consecutively diagnosed patients with tuberculosis (all types), aged 15-54 years. Controls were a representative population sample of 4161 people, drawn in a stratified cluster sample from urban areas, roadside settlements, and rural villages. HIV-1 infection was determined by ELISA and if the ELISA result was indeterminate by Western Blot. The HIV-1 prevalence in cases was 23.0% in rural, 32.1% in roadside, and 54.1% in urban areas, while in controls these prevalences were 3.4%, 7.2% and 12.1% respectively. The relative risk (RR) of HIV-1 infection for the development of active tuberculosis was estimated to be 8.3 (95% confidence interval [CI] 6.4-11.0). This risk varied little by sex or residence, but appeared to be more pronounced in the age group 25-34 years. The case detection rate of tuberculosis in those aged 15-54 years was 125/100,000 people per year. The population attributable risk was 36/100,000 people per year, implying that 29% of tuberculosis cases at present may be attributable to HIV-1 infection. It is concluded that HIV-1 infection is a major contributing factor to the increased case detection rate of tuberculosis observed over the past 10 years in Mwanza Region. If the prevalence of HIV-1 continues to increase, the incidence of tuberculosis will continue to rise as well.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of pulmonary tuberculosis in adult population of Tanzania: a national survey, 2012

“…Third, declining HIV burden and increasing coverage of anti-retroviral therapy in Tanzania might be influencing this risk analysis [100][101][102]. Studies in 1990s showed that about 30% of incident tuberculosis cases were attributable to HIV [103,104], but in our study the population attributable fraction (PAF) for HIV in prevalent tuberculosis cases was 3%, indicating that HIV may not be as strong driver of the tuberculosis prevalence in Tanzania as before.…”

The Growing Burden of Tuberculosis

“…Paired HIV prevalence data from patients with TB and general populations were obtained from previous publications, 10,42,43,[46][47][48][49][50][51]98,99 the US Centers for Disease Control and Prevention, 45,46 the HIV database kept by the US Census Bureau, 102 and UNAIDS. 36 Mostdatawerefromsub-Saharan Africa, as shown in Figure 2A and B.…”

Tuberculosis in Maintenance Dialysis Patients

“…However, only a few reports with a small number of cases, describing dialysis patients with TB, have been proposed [6, 7, 8, 9, 10, 11]. Additionally, increased prevalence of HIV infection and ethnic factors, which were the risk factors of TB, renders the understanding of behavior of TB in dialysis patients more difficult [7, 12, 13]. In an attempt to find the incidence and characteristics of TB in dialysis patients, we collected all the cases of newly diagnosed TB and dialysis patients in Taiwan during 1997.…”