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

HIV Med. 2008 Apr;9(4):227-33. doi: 10.1111/j.1468-1293.2008.00550.x.

Abstract

Objectives: To evaluate the impact of immigration on tuberculosis (TB)-HIV co-infection in Spain in a prospective cohort of HIV patients.

Methods: Among 7761 HIV patients, we evaluated 1284 with at least one episode of TB between 1987 and 2006. Variables were compared between immigrants and Spaniards.

Results: Incidence of TB decreased from 20 to five cases per 100 patient-years in 2006 (P<0.01) 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%, P<0.001). 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).

Conclusions: Immigrants 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Africa / ethnology
  • Americas / ethnology
  • Asia / ethnology
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes
  • Emigrants and Immigrants
  • Europe / ethnology
  • European Continental Ancestry Group
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / immunology
  • Humans
  • Incidence
  • Male
  • Morbidity / trends
  • Prospective Studies
  • Risk Factors
  • Spain / epidemiology
  • Tuberculosis / epidemiology*