The growing impact of HIV infection on the epidemiology of tuberculosis in England and Wales

Abstract

Background: Previous studies have estimated the prevalence of tuberculosis and HIV infection in population subgroups in the UK. This study was undertaken to describe recent trends in the proportion of individuals with HIV infection among reported cases of tuberculosis in England and Wales, and to review the implication for clinical and public health care. Methods: A population-based matching study using national surveillance databases was used to investigate all persons aged 15 years and over reported with a diagnosis of tuberculosis to the Health Protection Agency from England and Wales, 1999-2003. Record linkage was used to match the national tuberculosis and HIV/AIDS surveillance databases to identify all cases of tuberculosis and determine the proportion of tuberculosis patients co-infected with HIV. We determined the distribution and characteristics of cases and examined trend by year. Results: Of 30,670 tuberculosis cases reported in England and Wales between 1999 and 2003, an estimated 1,743 (5.7%) were co-infected with HIV. There was a year on year increase in the proportion from 3.1% (169/5388) in 1999 reaching 8.3% (548/6584) in 2003 (p for trend <0.0001). Co-infected patients contributed to almost a third of the increase in the number of tuberculosis cases during the five year period. Patients co-infected with HIV were predominantly those born abroad. 18.5% (323) of co-infected patients had not been reported as active tuberculosis cases on the national tuberculosis database. Conclusion: The proportion of tuberculosis patients co-infected with HIV in England and Wales is increasing, with the greatest impact on those born abroad regardless of their ethnic origin. With HIV infection contributing substantially to the increase in number of tuberculosis cases, close cooperation in the clinical management and accurate notification of patients is vital if appropriate care and public health action is to be achieved.