Abstract
The number of patients with tuberculosis (TB) increased steadily in Scotland between 2005 and 2010. Human immunodeficiency virus (HIV) infection has been a contributory factor to increases in TB in a number of comparable industrialised countries. This study investigated the extent of, and risk factors for, TB and HIV coinfection in Scotland from 2001 to 2010. Patients with TB in the national TB database were linked to those in the national HIV database using probabilistic data linkage. Patient records were anonymised to maintain confidentiality. From 2001 to 2010, 106/4, 097 (2.6%, 95% CI: 2.1 to 3.1) TB patients matched with HIV patients, equating to a 10-year incidence of 2.1 cases per million population. Patients with both TB and HIV were more often born outside the United Kingdom,were of black African ethnicity, had refugee status and had extra-thoracic lymph node involvement or cryptic/disseminated TB disease. Individuals with TB and HIV coinfection were younger and symptomatic for a shorter time before their diagnosis of TB, compared with TB patients without HIV. TB and HIV coinfection was relatively uncommon in Scotland in the study period. Clinicians should recognise the potential for HIV infection among TB patients and the importance of offering an HIV test to all TB patients.
Highlights
Human immunodeficiency virus (HIV) infection and associated immunosuppression is a major risk factor for the development of active tuberculosis (TB), either through acquisition of new infection or re-activation of latent TB [1]
From 2001 to 2010, 4,097 tuberculosis cases were reported to Health Protection Scotland, of which 106 (2.6%; 95% confidence interval (CI): 2.1–3.1) were matched to an individual on the HIV database, equating to a 10-year incidence of 2.1 cases per million population
Our analysis showed that having TB and HIV coinfection was associated with an increased likelihood of pulmonary TB (odds ratio (OR): 2.2, p = 0.004), extra-thoracic lymph node involvement (OR: 3.8 (95%: CI 2.1–6.7), p < 0.0001) or cryptic/ disseminated TB (OR: 5.7, p < 0.0001) when compared with TB cases without HIV
Summary
Human immunodeficiency virus (HIV) infection and associated immunosuppression is a major risk factor for the development of active tuberculosis (TB), either through acquisition of new infection or re-activation of latent TB [1]. The TB action plan for Scotland [11] recommends that the HIV status of all TB cases be known as this is a requirement for annual reporting to the European Tuberculosis Surveillance Network at the European Centre for Disease Prevention and Control (ECDC) [12]. Despite these recommendations, the HIV status of TB cases remains unknown at a national level in Scotland as these data are not routinely collected or linked. We used record linkage from 1984 to 2010 to investigate the extent of TB and HIV coinfection and identify risk factors for TB and HIV coinfection in Scotland
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