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Investigators in the United Kingdom
(UK) studied three national databases to determine the incidence of TB among
HIV-infected heterosexuals living in England and Wales from 2002 to 2010.
Results based on these databases show that, throughout this time period,
incidence of TB decreased from 30 per 100 individuals to 8.8 per 1,000
individuals. The databases indicated that 45,322 heterosexuals received
treatment for HIV infection in England and Wales; 4,266 of these individuals
also were diagnosed with active TB. More than half of the individuals (54
percent) received an initial simultaneous diagnosis of HIV and TB, while 38
percent were diagnosed with TB more than three months after their HIV
diagnosis. Almost all of the simultaneous diagnosis patients (92 percent) were
diagnosed late with HIV and 53 percent had a CD4 cell count lower than 100
cells per cubic millimeter.
According to the investigators, this
decrease is due both to a fall in the number of TB diagnoses and an increase in
the total number of heterosexual adults living with HIV. Also, the
investigators believe that patients are becoming less susceptible to TB. There
was a drop in the number of heterosexuals in the United Kingdom acquiring HIV
in sub-Saharan Africa, where there is a high prevalence of TB. Approximately 84
percent of the patients diagnosed with TB were black Africans.
Factors associated with TB
coinfection included gender (male versus female), ethnicity (black African,
Indian, Pakistani, or Bangladeshi), and acquiring HIV abroad. Also, the use of
antiretroviral therapy (ART) among persons with a CD4 cell count less than 350
cells per cubic millimeter increased in response to national HIV treatment
guidelines.
The TB incidence among HIV-infected
heterosexuals was significantly higher than in the general UK population (0.14
per 1,000 individuals). Incidence of TB among HIV-infected black Africans (11
per 1,000 individuals) was approximately four times higher than the UK rate for
HIV-negative Africans born abroad (2.7 per 1,000 individuals) and 25 times
higher than the rate among HIV-negative black Africans born in the UK (0.43 per
1,000 individuals). The incidence of TB among HIV-positive persons not taking
ART was more than 14 times higher than those on ART (56 per 1,000 individuals
versus 3.9 per 1,000 individuals). The highest TB incidence for the study
period was among persons not taking ART, who had a CD4 cell count below 200
cells per cubic millimeter .
The study, “Decreasing Incidence of
Tuberculosis Among Heterosexuals Living with Diagnosed HIV in England and
Wales,” was published online in the journal AIDS (doi:10.1097/QAD.0b013e32835e2cb1).
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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