Abstract
The aim of our study was to evaluate the seasonal variations and whether short-term exposure to environmental risk factors, such as climate and air pollution, is associated with PTB-related hospital admissions in human immunodeficiency virus (HIV)-infected patients in Spain during the era of combined antiretroviral therapy (cART). A retrospective study was carried out using data from the Minimum Basic Data Set (MBDS) and the State Meteorological Agency (AEMET) of Spain. The primary outcome variable was hospital admissions with PTB diagnosis. The environmental risk factors evaluated were season, temperature, humidity, NO2, SO2, O3, PM10, and CO. Overall, HIV-infected patients had a lower frequency of PTB-related hospital admissions in summer (22.8%) and autumn (22.4%), but higher values in winter (26.6%) and spring (28.2%). Using a Bayesian temporal model, PTB-related hospital admissions were less frequent in summer-autumn and more abundant in winter-spring during the first years of follow-up. During the later years of follow-up, the seasonal trends continued resulting in the lowest values in autumn and the highest in spring. When considering short-term exposure to environmental risk factors, lower temperatures at 1 week (odds ratio (OR) = 1.03; p = 0.008), 1.5 weeks (OR = 1.03; p<0.001), 2 weeks (OR = 1.04; p<0.001), and 3 weeks (OR = 1.03; p<0.001) prior to PTB admission. In addition, higher concentration of NO2 at the time of admission were significantly associated with higher likelihoods of PTB-related hospital admission in HIV-infected patients when 1.5 weeks (OR = 1.1; p = 0.044) and 2 weeks (OR = 1.21; p<0.001) were used as controls. Finally, higher concentration of SO2 at 1.5 weeks prior to PTB admission was significantly associated with a higher likelihood of PTB-related hospital admissions (OR = 0.92; p = 0.029). In conclusion, our data suggest an apparent seasonal variation in hospital admissions of HIV-infected patients with a PTB diagnosis (summer/autumn vs. winter/spring), as well as a link to short-term exposure to environmental risk factors, such as temperature and ambient NO2 and SO2.
Highlights
Tuberculosis remains one of the world’s deadliest communicable diseases
Human immunodeficiency virus (HIV) infection is the most important risk factor for developing tuberculosis in patients already infected with Mycobacterium tuberculosis [2,3], and tuberculosis is the most common acquired immunodeficiency syndrome (AIDS)-defining condition worldwide [4]
The National Health System (NHS) provides free medical care to 99.5% of the Spanish population, those persons not covered by the NHS can be attended to at the public hospitals
Summary
Tuberculosis remains one of the world’s deadliest communicable diseases. Despite notable progress in the last decades, tuberculosis is still a public health concern in most of the countries within the WHO European Region [1]. Human immunodeficiency virus (HIV) infection is the most important risk factor for developing tuberculosis in patients already infected with Mycobacterium tuberculosis [2,3], and tuberculosis is the most common acquired immunodeficiency syndrome (AIDS)-defining condition worldwide [4]. In 2014, 9.6 million people developed tuberculosis and around 1.5 million died from the disease. At least one-third of people living with HIV worldwide were infected by tuberculosis. Among European Union/European Economic Area countries, Spain had one of the highest incidences of AIDS (from 1994 to 2009) and tuberculosis (from 1995 to 2009) [6,7]
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