Skip to main content

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


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.


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.


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.


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.

Author information

Authors and Affiliations


Corresponding author

Correspondence to John Metcalfe.

Rights and permissions

Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and permissions

About this article

Cite this article

Metcalfe, J., Facer, M., Damesyn, M. et al. Evolution of tuberculosis/HIV co-infection in California during the HAART Era, 1996-2007. Retrovirology 7 (Suppl 1), O1 (2010).

Download citation

  • Published:

  • DOI: