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The growing impact of HIV infection on the epidemiology of tuberculosis in England and Wales: 1999–2003
  1. Aliko B Ahmed1,
  2. Ibrahim Abubakar1,2,
  3. Valerie Delpech1,
  4. Marc Lipman3,
  5. Delia Boccia1,
  6. Josh Forde1,
  7. Delphine Antoine1,
  8. John M Watson1
  1. 1Centre for Infections, Health Protection Agency, Colindale, London, UK
  2. 2School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
  3. 3Royal Free Hospital, London, UK
  1. Correspondence to:
    Dr John M Watson
    Respiratory Diseases Department, Centre for Infections, Health Protection Agency, London NW9 5EQ, UK; john.watson{at}


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 implications 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 in England and Wales in 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 patients with tuberculosis co-infected with HIV. The distribution and characteristics of the cases were determined and the trend examined by year.

Results: Of 30 670 cases of tuberculosis reported in England and Wales between 1999 and 2003, an estimated 1743 (5.7%) were co-infected with HIV. There was a year on year increase in the proportion from 3.1% (169/5388) in 1999 to 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 cases of tuberculosis during the 5 year period. Patients co-infected with HIV were predominantly those born abroad. 18.5% (n = 323) of co-infected patients had not been reported as active cases of tuberculosis on the national tuberculosis database.

Conclusion: The proportion of patients with tuberculosis 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 the number of cases of tuberculosis, close cooperation in the clinical management and accurate notification of patients is vital if appropriate care and public health action is to be achieved.

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  • Published Online First 20 February 2007

  • Funding: None.

  • Competing interests: None declared.

  • This study was carried out with national surveillance data. The Health Protection Agency has Patient Information Advisory Group approval to hold and analyse national surveillance data for public health purposes under Section 60 of the Health and Social Care Act 2001. No patients’ names are collected for HIV surveillance; instead, surname Soundex codes are used and strict confidentiality of the data is maintained.

    All authors have seen and approved the final manuscript. In addition, ABA wrote the first draft of the manuscript and IA conducted the analysis. All authors contributed to the design of the study, interpretation of the data and writing of the paper. JMW is guarantor.

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