A recent study published in the journal BMC Medicine, reported a substantial decline in tuberculosis-HIV co-infection since 2004 in England, Wales and Northern Ireland. However, black Africans with tuberculosis born in countries with high HIV prevalence showed higher rates of HIV. While the current policy of testing all patients with tuberculosis for HIV is important for proper management of patients with tuberculosis, many of these cases would be preventable if HIV could be diagnosed before tuberculosis develops.
This retrospective study evaluated 106,829 tuberculosis cases reported in adults (aged, ≥15 years) between 2000 and 2014. HIV was identified in 5792 patients.
Proportion of tuberculosis patients infected with HIV decreased from 8% in 2004 to 3.2% in 2014. Proportion of patients diagnosed with HIV first rose from 33.5% in 2000 to 57.1% in 2014 whereas patients diagnosed with tuberculosis first fell from 22.8% to 4.4%. HIV infection was most frequent in patients with tuberculosis of black African ethnicity born in countries with a high HIV prevalence (32.3%). Drug misuse (OR, 2.70; P<.001) was the only social risk factor positively associated with HIV infection.
Authors speculate that reduction in proportion of patients diagnosed with tuberculosis before HIV could be because of increased HIV testing. They further comment: “Many tuberculosis cases would be preventable if HIV could be diagnosed before tuberculosis develops.” They add that “Improving screening for both latent tuberculosis and HIV and ensuring early treatment of HIV in these populations could help prevent these tuberculosis cases.”