Tuberculosis Incidence in HIV-AIDS Patients in Israel, 1983–2010Report as inadecuate




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Objectives

People living with HIV-AIDS PLWHA who develop tuberculosis disease are at greater mortality-risk. This study aimed to assess tuberculosis disease incidence among all PLWHA in Israel and identify populations at high-risk for developing tuberculosis.

Design and Methods

Retrospective cohort-study based on the National HIV and Tuberculosis Registries, which were cross-matched and followed for the last 28-years. PLWHA who developed tuberculosis were compared to those who did not by the Cox-proportional analysis to generate hazard-ratios, and survival-analysis was performed by Log-Rank test.

Results

Of all the 6579 PLWHA reported between 1983 and 2010, corresponding to 55737 person-years, 384 5.8% developed tuberculosis. Of those, 14 were Israeli-born and 370 were non-Israeli born. The overall tuberculosis incidence-density was 6.9 cases-1000 person-years 95% CI 1.8–12.0. The cumulative tuberculosis-incidence among PLWHA in 2010 was 586 times higher than in HIV-negative individuals 3400 and 5.8 cases per 100000 population, respectively. Higher hazard-ratios to developing tuberculosis were found in migrant citizens PLWHA who were males, non-Israeli born, those who were diagnosed with HIV-AIDS after 1997, those who originated in high-tuberculosis prevalence country and those who acquired HIV by heterosexual or drug-injection transmission. PLWHA who developed tuberculosis had higher odds of dying than other PLWHA 36.5% and 16.6%, respectively, p<0.001, odds ratio = 2.8, 95% confidence-interval 2.3–3.6. In survival-analysis, time to develop tuberculosis was shorter among males than females, in PLWHA who were reported with HIV after 1997, in heterosexual who originated in high-tuberculosis countries, followed by injecting drug-users, heterosexual from low-tuberculosis burden countries and men who have sex with men.

Conclusion

Tuberculosis-incidence is higher among non-Israeli born PLWHA, with decreasing trends from 1991. Despite the moderate TB-rate disease among PLWHA, it remains an important cause for severe morbidity and mortality. Tuberculosis in PLWHA reflects mainly the tuberculosis-burden in the originating country and possibly also the mode of HIV-transmission.



Author: Zohar Mor , Moshe Lidji, Noa Cedar, Itamar Grotto, Daniel Chemtob

Source: http://plos.srce.hr/



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