HIV-associated tuberculosis and immigration in a high-income country: incidence trends and risk factors in recent years.

OBJECTIVE

To examine trends in tuberculosis incidence rates in France during the combination antiretroviral therapy (cART) period.

METHODS

From the French Hospital Database on HIV, we selected 72 580 patients (including 14 491 migrants) with no history of tuberculosis, followed between 1 January 1997 and 31 December 2008. We then examined incidence rates of tuberculosis and its risk factors.

RESULTS

A total of 2625 patients were diagnosed with tuberculosis either at enrollment (N = 932) or during follow-up (N = 1693). During follow-up, the incidence rate of tuberculosis was 0.40/100 patient-years overall, 0.20 among non-migrants and 1.03 among migrants. Adjusted risk of tuberculosis was 2.01 [95% confidence interval (CI) 1.79-2.26] times higher in migrants than in non-migrants. The adjusted incidence rate of tuberculosis significantly increased in both migrants and non-migrants after 2000-2001, with adjusted risks of 2.50 (95% CI 1.54-4.06) and 1.85 (95% CI 1.27-2.69) in 2008 compared with that in 1997, respectively. Other factors independently associated with a higher incidence of tuberculosis were medical follow-up less than or equal to 6 months, no previous antiretroviral therapy, lower CD4 cell count and higher viral load. Non-migrant patients belonging to HIV-transmission groups other than homosexual men, residing in the Paris area or in French West Indies or with AIDS status were at a supplementary risk.

CONCLUSION

The incidence of tuberculosis is increasing among both migrant and non-migrant HIV-infected patients in France. This is partly because sub-Saharan African migrants represent an increasing fraction of the HIV-infected population in France and also because of late access to care. Co-prescribing tuberculosis preventive therapy with cART might benefit selected patients, such as migrants and patients with late access to care.