HIV-associated tuberculosis and immigration in a high-income country: incidence trends and risk factors in recent years

AIDS. 2010 Mar 13;24(5):763-71. doi: 10.1097/QAD.0b013e3283366747.


Objective: To examine trends in tuberculosis incidence rates in France during the combination antiretroviral therapy (cART) period.

Methods: From the French Hospital Database on HIV, we selected 72 580 patients (including 14 491 migrants) with no history of tuberculosis, followed between 1 January 1997 and 31 December 2008. We then examined incidence rates of tuberculosis and its risk factors.

Results: A total of 2625 patients were diagnosed with tuberculosis either at enrollment (N = 932) or during follow-up (N = 1693). During follow-up, the incidence rate of tuberculosis was 0.40/100 patient-years overall, 0.20 among non-migrants and 1.03 among migrants. Adjusted risk of tuberculosis was 2.01 [95% confidence interval (CI) 1.79-2.26] times higher in migrants than in non-migrants. The adjusted incidence rate of tuberculosis significantly increased in both migrants and non-migrants after 2000-2001, with adjusted risks of 2.50 (95% CI 1.54-4.06) and 1.85 (95% CI 1.27-2.69) in 2008 compared with that in 1997, respectively. Other factors independently associated with a higher incidence of tuberculosis were medical follow-up less than or equal to 6 months, no previous antiretroviral therapy, lower CD4 cell count and higher viral load. Non-migrant patients belonging to HIV-transmission groups other than homosexual men, residing in the Paris area or in French West Indies or with AIDS status were at a supplementary risk.

Conclusion: The incidence of tuberculosis is increasing among both migrant and non-migrant HIV-infected patients in France. This is partly because sub-Saharan African migrants represent an increasing fraction of the HIV-infected population in France and also because of late access to care. Co-prescribing tuberculosis preventive therapy with cART might benefit selected patients, such as migrants and patients with late access to care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology*
  • AIDS-Related Opportunistic Infections / transmission
  • Adult
  • Africa South of the Sahara / ethnology
  • CD4 Lymphocyte Count
  • Emigration and Immigration / statistics & numerical data*
  • Female
  • France / epidemiology
  • Humans
  • Incidence
  • Male
  • Risk Factors
  • Tuberculosis / epidemiology*
  • Tuberculosis / transmission
  • Viral Load