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Open Access

Evolution of tuberculosis/HIV co-infection in California during the HAART Era, 1996-2007

  • John Metcalfe1Email author,
  • Matt Facer2,
  • Mark Damesyn2,
  • Qiang Xia2,
  • James Watt3,
  • Julia Hill3,
  • Philip Hopewell1,
  • Janice Westenhouse3 and
  • Jennifer Flood3
Retrovirology20107(Suppl 1):O1

https://doi.org/10.1186/1742-4690-7-S1-O1

Published: 11 May 2010

Keywords

PyrazinamideIsoniazid ResistanceForeign BirthForeign Born PatientBorn Patient

Background

California reports the highest annual number of tuberculosis (TB) cases and over 12% of all persons living with HIV in the US. To assess changes in the intersection of these diseases, we analyzed state-wide data from both registries.

Methods

Incident cases reported to the California TB registry from 1996 to 2007, inclusive, were cross-matched with the state HIV/AIDS registry. Incidence rates of TB with and without HIV co-infection were analyzed for changes in trend. Sociodemographic, clinical characteristics, and treatment outcomes were examined.

Results

2,392 (6%) of 39,718 TB cases during the study period were matched in the state AIDS registry. From 1996 to 2006, annual TB incidence among persons with HIV declined from 368/100,000 to 73/100,000, and without HIV declined from 12.7/100,000 to 7.3/100,000. Comparing the period 1996-2000 with 2001-2007, the proportion of TB/HIV cases increased among Hispanics (48% to 57%; p < .001), foreign born (46% to 63%; p < .001), and women (14% to 18%; p = .06), and decreased among Blacks (28% to 21%; p < .001). Male-to-male sexual contact (44% to 41%; p < .01) and injection drug use (21% to 15%; p < .01) decreased, and high-risk heterosexual contact (9% to 16%; p < .01) increased as HIV transmission routes. 77% of all foreign born patients with TB/HIV co-infection originated from Mexico or Central America; the median time from immigration to TB diagnosis was 10.7 (IQR 4-19) years. CD4 count at TB diagnosis (median 78 (IQR 30-167)) was available for 54% of patients. Patients with HIV co-infection were more likely to be sputum smear-positive (OR 1.17 (95% CI 1.08-1.28). Both isoniazid resistance (5% to 7%; p = .07) and pyrazinamide monoresistance (6% to 8%; p = .01) increased over time in TB/HIV cases but not in cases without HIV. In multivariate analysis, Hispanic ethnicity, older age, and injection drug use were inversely associated with treatment success among TB/HIV cases.

Discussion

In California, the epidemiology of TB/HIV co-infection in the post-HAART era has shifted towards persons of foreign birth, women, Hispanics, and those who acquired HIV through heterosexual sex. In addition, drug resistance has increased in TB/AIDS cases. These changes should be considered in focusing TB and HIV disease prevention and treatment efforts.

Authors’ Affiliations

(1)
UCSF, San Francisco, USA
(2)
Office of AIDS, California Department of Public Health, San Francisco, USA
(3)
TB Control Unit, California Department of Public Health, Richmond, USA

Copyright

© Metcalfe et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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