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Free Content Impact of the human immunodeficiency virus on the epidemiology of tuberculosis in area 15 of the Valencian Community in Spain

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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.

Keywords: HIV; epidemiology; incidence; tuberculosis

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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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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