Abstract
Tuberculosis (TB) and HIV comorbidity is a major challenge in TB prevention and control but difficult to assess in Germany as in other countries, where data confidentiality precludes notifying the HIV status of TB patients. We aimed to estimate the HIV-prevalence in TB patients in Germany, 2002–2009, and to characterize the HIV/TB patients demographically. Data from the long-term observational open multicentre cohort ClinSurv HIV were used to identify incident TB in HIV-positive individuals. We assessed the cohort’s coverage for the nationwide HIV-positive population by contrasting ClinSurv HIV patients under antiretroviral therapy (ART) with national HIV patient numbers derived from ART prescriptions (data by Insight Health; available for 2006–2009). The HIV-prevalence in TB patients was calculated as the number of HIV/TB cases projected for Germany over all culture-positive TB notifications. From 2002 to 2009, 298 of 15,531 HIV-positive patients enrolled in the ClinSurv HIV cohort were diagnosed with TB. A 21% cohort coverage was determined. The annual estimates of the HIV-prevalence in TB patients were on average 4.5% and ranged from 3.5% (95%CI 2.3–5.1%) in 2007 to 6.6% (95%CI 5.0–8.5%) in 2005. The most recent estimate for 2009 was 4.0% (95%CI 2.6–5.9%). The 298 HIV/TB patients were characterized by a male-to-female ratio of 2.1, by a median age of 38 years at TB diagnosis, and by 59% of the patients having a foreign origin, mainly from Subsahara Africa. We provide, to our knowledge, the first estimate of the HIV-prevalence in TB patients for Germany by joint evaluation of anonymous HIV and TB surveillance data sources. The identified level of HIV in TB patients approximates available surveillance data from neighbouring countries and indicates a non-negligible HIV/TB burden in Germany. Our estimation approach is valuable for epidemiological monitoring of HIV/TB within the current legal frameworks.
Highlights
Tuberculosis (TB) and HIV comorbidity is a relevant public health issue worldwide and does not spare the European region [1,2,3]
HIV-positive individuals infected with Mycobacterium (M.) tuberculosis complex bacteria are placed at a 20 to 30 times greater risk of developing active TB [7,8,9]; they are more prone to endogenous reactivation or exogenous reinfection than HIV-negative individuals [7,8,10,11]
From 1999 to 2009, a total of 15,531 HIV-positive individuals were enrolled in the ClinSurv HIV cohort
Summary
Tuberculosis (TB) and HIV comorbidity is a relevant public health issue worldwide and does not spare the European region [1,2,3]. HIV/TB is considered a leading cause, together with multiand extensively drug resistant tuberculosis (M/XDR-TB), impairing success in TB control [4,5]. Both HIV and TB adversely interact when affecting the same patient: TB as an AIDS-defining disease is a major cause of morbidity and mortality in people living with HIV (PLWH) [1,6]. Diagnosis of latent infection and active TB is more challenging in immunocompromised individuals including PLWH [12] They may present with atypical clinical manifestations of TB or have masked disease with implications on adequate clinical case management [12,13]
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