Quantitative impact of human immunodeficiency virus infection on tuberculosis dynamics

Am J Respir Crit Care Med. 2007 Nov 1;176(9):936-44. doi: 10.1164/rccm.200603-440OC. Epub 2007 Aug 9.


Rationale: Human immunodeficiency virus (HIV) infection has a major but unquantified impact on the risk of tuberculosis.

Objectives: To quantify the impact of HIV infection on the number of tuberculosis cases in San Francisco.

Methods: We studied all patients reported with tuberculosis in San Francisco from 1991 to 2002. The initial isolates of Mycobacterium tuberculosis were genotyped using IS6110 restriction fragment-length polymorphism genotyping as the primary method, and clustered cases (identical genotype patterns) were identified.

Measurements and main results: We determined the case number, case rate, and the fraction of tuberculosis attributable to HIV infection. Of 2,991 reported tuberculosis cases, 2,193 (73.3%) had a genotype pattern of M. tuberculosis available. Genotypic clusters with at least one HIV-positive person were larger, lasted longer, and had a shorter time between successive cases relative to clusters with only HIV-uninfected persons (P < 0.00005, P = 0.0009, P = 0.018, respectively). Overall, 13.7% of the tuberculosis cases were attributable to HIV infection and an estimated 405 excess tuberculosis cases occurred.

Conclusions: During a period encompassing the resurgence and decline of tuberculosis in San Francisco, a substantial number of the tuberculosis cases were attributable to HIV infection. Coinfection with HIV amplified the local tuberculosis epidemic.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Antiretroviral Therapy, Highly Active
  • Case-Control Studies
  • Cluster Analysis
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Risk Factors
  • San Francisco / epidemiology
  • Time Factors
  • Tuberculosis / epidemiology*
  • Tuberculosis / transmission