The changing pattern of tuberculosis and HIV co‐infection in immigrants and Spaniards in the last 20 years

Abstract

ObjectivesTo evaluate the impact of immigration on tuberculosis (TB)-HIV co-infection in Spain in a prospective cohort of HIV patients. MethodsAmong 7761 HIV patients, we evaluated 1284 with at least one episode of TB between 1987 and 2006. Variables were compared between immigrants and Spaniards. ResultsIncidence of TB decreased from 20 to five cases per 100 patient-years in 2006 (Po0.01) and was always higher in immigrants than in Spaniards. The proportion of immigrants increased, reaching almost 50% of both new cases of HIV and TB-HIV co-infection in 2006. In 34.4% of patients, TB and HIV infection were diagnosed within the same year; simultaneous diagnosis was more frequent in immigrants (83.3% vs. 16.7%, Po0.001). Mortality was associated independently with age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01-1.05], TB diagnosis before 1996 (HR 2.6, 95% CI 1.8-3.6), use of highly active antiretroviral treatment (HR 0.494, 95% CI 0.37-0.66) and CD4 cell count at TB diagnosis (HR 0.996, 95% CI 0.995-0.997). ConclusionsImmigrants have a major impact on the incidence of TB in HIV patients, slowing down the decreasing trend in Spain. Simultaneous diagnosis of the co-infection in immigrants reveals a need to intensify HIV case finding in immigrants in Spain.Keywords: HIV infection, immigrants, incidence, trend, tuberculosis IntroductionTuberculosis (TB) is a common AIDS-defining condition in Spain and is one of the most common causes of morbidity and mortality in HIV-infected people, especially in less developed countries [1][2][3]. Both entities constitute a great burden of disease. Between 1990 and 2005, the incidence of TB increased by an average of 7.0% per year in countries with high adult HIV prevalence (45%) compared with 1.3% per year in countries with lower HIV prevalence [4].Although highly active antiretroviral treatment (HAART) reduced by 70-90% the risk of developing TB, access to HAART may be different in countries with high prevalence of TB [5]. These are usually the origin countries of immigration also in Spain [6]. Little is known about the impact of immigrant HIV-infected patients with TB on the epidemiology of a country with a lower prevalence of both diseases.A number of studies have addressed TB and immigration and the issue of TB and HIV infection in developed countries [6][7][8]. However, few studies have focused on the intersection of these phenomena: TB in the immigrant and HIV population from the perspective of an HIV cohort.We designed this study to describe the trends in TB-HIV co-infection among a cohort of HIV-infected individuals in Spain, to describe the epidemiological and clinical Correspondence: María Velasco, Infectious Diseases Unit, Internal Medicine, Fundació n Hospital Alcorcó n, 1 C/Budapest, 28922 Alcorcó n, Madrid, Spain. Tel: 1 34 91 621 9597; fax: 1 34 91 621 9905; e-mail: mvelasco@fhalcorcon.es DOI: 10.1111DOI: 10. /j.1468DOI: 10. -1293DOI: 10. .2008 (2008), 9, 227-233 227 characteristics of co-infected patients and to investigate the predictors of survi...

Infección VIH/Sida y otras infecciones de transmisión sexual en la población inmigrante en España: revisión bibliográfica

“…I de ASS y NA mayor transmisión heterosexual 5,29,41 . EE y A mayor transmisión por UDVP 5 En I y A la exposición más frecuente fue la relación sexual 19,5,20,22,28,29,34 . I y A TS mayor riesgo de transmisión en las relaciones sexuales personales 24,35,42 .…”

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“…8 , 29 , 30 However, the endemic nature of TB-AIDS co-infection in countries of origin may not be sufficient to explain this finding. In the case of immigrants with latent tuberculosis infection (LTI) alone, the social group into which immigrants integrate in the receiving country could determine their risk of HIV infection and, therefore, the occurrence of AIDS–TB cases.…”

The burden of TB–HIV in the EU: how much do we know? A survey of surveillance practices and results

“…In Europe, recent trends in migration, and transmission of TB and HIV in hard-to-reach communities and congregate settings, may result in increasing numbers of TB-HIV co-infected cases [6][7][8][9]. The latest data for the European Union (EU) and European Economic Area (EEA; EU plus Iceland, Liechtenstein and Norway) show that between 0% and 15% of TB cases are co-infected with HIV in the 30 EU/EEA Member States with a varying degree of HIV testing coverage among TB patients [10].…”