Impact of the human immunodeficiency virus on the epidemiology of tuberculosis in area 15 of the Valencian Community in Spain
Abstract:SETTING: Area 15 in Valencia.
OBJECTIVES: To describe the epidemiology (1987–2001) of tuberculosis (TB) in human immunodeficiency virus (HIV) patients.
METHODS: Study of annual incidence, age distribution, excess cases attributed to HIV, etiological risk fraction (ERF), population attributable fraction (PAF) and f factor.
RESULTS: Of 476 cases diagnosed, 459 were TB, 16 environmental and one mixed; 76% of environmental cases were HIV-positive (P < 0.001). There was a mean annual TB incidence of 24.6/100000, with an annual reduction of 4%. Seventy-three patients were HIV co-infected (16%) (mean incidence 3834/100000 seropositives). The principal risk factor was drug use (59%) for HIV+ and contact with TB for HIV−. We found no difference in pulmonary or extra-pulmonary location between groups, contrary to mixed cases (P < 0.001). In HIV+ there was a lower frequency of infiltrates (P < 0.001) and cavitation (P < 0.01), and a higher frequency of adenitis (P < 0.001), miliary or nodular pattern and normal X-ray (P < 0.001). Seropositives had a 174 times higher probability of developing TB. The mean ERF attributed to HIV was 99%, the PAF was 16% and the f factor was 1.19. Highly active antiretroviral therapy (HAART) reduced the risk of TB in HIV+ by 80%.
CONCLUSIONS: TB has continued its decline, although HIV generated an excess of cases in the 1990s. HAART has reduced the TB risk in HIV+ and possibly the overall rate of TB.
Document Type: Regular Paper
Affiliations: 1: Pneumology Service, Hospital Marina Baixa, Alicante, Spain 2: San Juan de Alicante University Hospital, Alicante, Spain 3: Universitat de Valencia, Valencia, Spain 4: Infectious Disease Unity, General University Hospital, Alicante, Spain
Publication date: October 1, 2004
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