Trends in Tuberculosis/Human Immunodeficiency Virus Comorbidity, United States, 1993-2004

Abstract

Background: To our knowledge, this is the first assessment of trends in tuberculosis (TB)/human immunodeficiency virus (HIV) comorbidity in the United States based on national TB surveillance data. Methods:We analyzed all incident TB cases reported to the Centers for Disease Control and Prevention national TB surveillance system from all 50 states and the District of Columbia from 1993 through 2004. Trends in TB/HIV cases were examined according to selected demographic and clinical characteristics.Results: Cases of TB/HIV decreased from 3681 (15% of 25 108 TB cases) in 1993 to 1187 (8% of 14 515 TB cases) in 2004, accounting for 23% of the overall decrease in TB cases during this period. The TB/HIV case rate decreased from 1.4/100 000 in 1993 to 0.4/100 000 in 2004. The highest TB/HIV comorbidity rates persisted in persons aged 25 to 44 years (13.8%), males (9.7%), US-born persons (10.7%), non-Hispanic blacks (17.8%), and persons from the Northeast (11.0%) and the South (10.1%). Propensity stratification, used to account for the unequal probability of patients with TB being tested for HIV during the study period, did not show important differences in TB/HIV comorbidity trends.Conclusions: Comorbidity due to TB/HIV decreased substantially between 1993 and 2004, primarily in US-born persons in states that experienced a TB resurgence between 1985 and 1992. These decreases coincide with improvements in TB control and advances in HIV treatment and diagnosis. The overall decreases obscure the wide variation in comorbidity that exists among some demographic groups and the recent slowing in the decline over the past 3 years.

Factors related to HIV/tuberculosis coinfection in a Brazilian reference hospital

“…Previous studies demonstrated predominance in young adults averaging 33 years of age [12,21,25,26]. The results in our study reflect the prolonged survival of HIV patients, since the average age of those with registered cases of AIDS in Brazil between 2002 and 2005 was 35.4.…”

“…There is a much greater risk of HIV/TB co-infected patients developing active TB, either from the latent infection being reactivated or due to the rapid progression of a new infection [10][11][12][13]. The risk of developing active TB in HIV patients increases from 5 to 15% annually, due to the latent infection being reactivated; this depends on the degree of immunocompromise [12,14,15].…”

“…The risk of developing active TB in HIV patients increases from 5 to 15% annually, due to the latent infection being reactivated; this depends on the degree of immunocompromise [12,14,15]. A study conducted among gold miners in South Africa showed that the risk of TB doubles within one year of HIV infection, but only increases slightly during the following years [5].…”

“…For this reason, individuals infected with HIV have increased susceptibility to active tuberculosis. HIV is the main risk factor for the development of TB [10,12,[16][17][18].…”

HIV Status Determination Among Tuberculosis Patients From California During 2008

“…1,3,23 Providers who practice risk-based testing might miss HIV infection among female, foreign-born, or older patients, who are increasingly represented among HIV-infected TB patients. 24,25 Although this evaluation detected no or little HIV infection among patients younger than 15 years and patients older than 60 years, infection in these groups does occur. Nationally in 2005, HIV infection was detected in 1% of TB patients younger than 4 years, in 2% of those aged 5 to 14 years, and in 1% of those older than 64 years.…”