Tuberculosis e inmigración en un área sanitaria de Madrid. Situación epidemiológica y evolución en la década 1994-2003

Arnáez, Araceli Arce; Martínez, Jesús Íñigo; Ballesteros, Luisa Cabello; Arenales, Mar Burgoa

doi:10.1157/13077375

Cited by 29 publications

(10 citation statements)

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“…have been efficacious in Spain [14]. Given the fact that almost 50% of new HIV infections are in immigrants, specific preventative measures for the immigrant population are needed.Our data fit with those of previously published papers about the epidemiology of TB in Spain [8,11,15,16]. Of particular note is the finding that TB is almost 1000 times more frequent in HIV patients than in the whole population of Spain (around 20 cases per 100 000 inhabitants in the first years of the cohort).…”

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confidence: 91%

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

et al. 2008

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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...

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confidence: 91%

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

et al. 2008

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“…Study results from Spain are somewhat heterogeneous and most discuss immigrant TB case characteristics only. Some mention higher prevalence of HIV co-infection [11], [12] or higher latent TB infection rates [13], while others vary in the predominant clinical forms of TB [11], [12], [14], rates of drug resistance [13], or the proportion of lost to follow-up cases [15].…”

Section: Discussionmentioning

confidence: 99%

Social, Clinical and Microbiological Differential Characteristics of Tuberculosis among Immigrants in Spain

et al. 2011

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BackgroundTo identify the differential tuberculosis (TB) characteristics within the immigrant population with respect to natives in Spain.Methodology/Principal FindingsA prospective cohort study design was implemented to examine the TB cases diagnosed and starting standard antituberculous treatment in Spain, between January 1st 2006 and March 31st 2007. A logistic regression analysis was performed to determine differential characteristics. 1,490 patients were included in the study population, 1,048 natives and 442 (29.7%) immigrants. According to the multivariate analysis, the following variables were significantly associated with immigrant TB cases: younger age (OR = 3.79; CI:2.16–6.62), living in group situation (OR = 7.61; CI:3.38–12.12), lower frequency of disabled (OR:0.08; CI:0.02–0.26) and retired (OR:0.21; CI:0.09–0.48) employment status, lower frequency of pulmonary disease presentation (OR = 0.47; CI:0.24–0.92), primary or emergency care admission (OR = 1.80; CI:1.05–3.06 and OR = 2.16; CI:1.36–3.45), drug resistance (OR = 1.86; CI:1.01–3.46), treatment default (OR:2.12; CI:1.18–3.81), lower frequency of alcohol and cigarette consumption (OR = 2.10; CI:1.42–3.11 and OR = 2.85; CI:2.10–3.87 respectively), more directly observed treatment (OR = 1.68; CI:1.04–2.69), and poor understanding of TB disease and its treatment (OR = 3.11; CI:1.86–5.20). The low percentage of primary MDR-TB in the native population (0.1% vs. 2.2% of immigrants) should be noted.Conclusions/SignificanceThe differences show the need to introduce specific strategies in the management of TB within the immigrant population, including the improvement of social and work conditions.

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“…In Germany around 75% of au-pairs come from countries with a high prevalence and incidence of tuberculosis and may be infected without currently displaying symptoms of disease (Geerdes-Fenge and Loytved, 2011). A Spanish study showed, that active tuberculosis in foreigners is mostly diagnosed within 2 years after immigration (Arce Arnaez et al, 2005). A thirty year observation showed that the number of children who developed tuberculosis after extra-familial contacts increased and one source of infection have been immigrant caretakers (del Rosal et al, 2010).…”

Section: The Source Of Infection In Childrenmentioning

confidence: 99%

Maternal-child health

Groß¹,

Wydra²

2013

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Tuberculosis e inmigración en un área sanitaria de Madrid. Situación epidemiológica y evolución en la década 1994-2003

Cited by 29 publications

References 4 publications

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

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

Social, Clinical and Microbiological Differential Characteristics of Tuberculosis among Immigrants in Spain

Maternal-child health

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