Background: HIV increases the progression of latent tuberculosis (TB) infection to active disease and contributed to increased TB in the UK until 2004. We describe temporal trends in HIV infection amongst patients with TB and identify factors associated with HIV infection. Methods: We used national surveillance data of all TB cases reported in England, Wales and Northern Ireland from 2000 to 2014 and determined HIV status through record linkage to national HIV surveillance. We used logistic regression to identify associations between HIV and demographic, clinical and social factors. Results: There were 106,829 cases of TB in adults (≥15years) reported from 2000 to 2014. The number and proportion of TB patients infected with HIV decreased from 543/6782 (8.0%) in 2004 to 205/6461 (3.2%) in 2014. The proportion of patients diagnosed with HIV >91days prior to their TB diagnosis increased from 33.5% in 2000 to 60.2% in 2013. HIV infection was highest in people of black African ethnicity from countries with high HIV prevalence (32.3%), patients who misused drugs (8.1%) and patients with miliary or meningeal TB (17.2%). Conclusions: There has been an overall decrease in TB-HIV co-infection and a decline in the proportion of patients diagnosed simultaneously with both infections. However, high rates of HIV remain in some sub-populations of patients with TB, particularly black Africans born in countries with high HIV prevalence and people with a history of drug misuse. Whilst the current policy of testing all patients diagnosed with TB for HIV infection is important in ensuring appropriate management of TB patients, many of these TB cases would be preventable if HIV could be diagnosed before TB develops. Improving screening for both latent TB and HIV and ensuring early treatment of HIV in these populations could help prevent these TB cases. British HIV Association guidelines on latent TB testing for people with HIV from sub-Saharan Africa remain relevant, and latent TB screening for people with HIV with a history of drug misuse, homelessness or imprisonment should also be considered.
Bibliographical noteFunding Information:
JRW was funded by a University College London (UCL) IMPACT studentship. This report is the result of independent research supported by the National Institute for Health Research (NIHR, Post Doctoral Fellowship, HRS, PDF-2014-07-008). IA is supported by the NIHR (SRF-2011-04-001, NF-SI-0616-10037), the Medical Research Council, the UK Department of Health and the Wellcome Trust. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funding source had no involvement in the study design; the collection, analysis and interpretation of the data; the writing of the report; or the decision to submit the paper for publication.
HRS reports grants from the National Institute of Health Research, outside the submitted work. CJS reports personal fees from Gilead and Janssen, outside the submitted work. AP is chair of the BHIVA guidelines committee. All other authors declare that they have no competing interests.
© 2018 The Author(s).
- Drug misuse
- Latent tuberculosis