Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
National Infections Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
BMC Med. 2018 Jun 7;16(1):85. doi: 10.1186/s12916-018-1070-2.
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.
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.
There were 106,829 cases of TB in adults (≥ 15 years) 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 > 91 days 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%).
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.
HIV 会加速潜伏性结核（TB）感染向活动性疾病的发展，并导致 2004 年之前英国结核病发病率上升。我们描述了结核病患者中 HIV 感染的时间趋势，并确定了与 HIV 感染相关的因素。
我们使用了 2000 年至 2014 年英格兰、威尔士和北爱尔兰所有报告的结核病病例的国家监测数据，并通过与国家 HIV 监测系统的记录链接确定 HIV 状态。我们使用逻辑回归来确定 HIV 与人口统计学、临床和社会因素之间的关联。
2000 年至 2014 年期间，共报告了 106829 例成人（≥15 岁）结核病病例。感染 HIV 的结核病患者数量和比例从 2004 年的 543/6782（8.0%）下降到 2014 年的 205/6461（3.2%）。HIV 诊断时间早于结核病诊断时间 91 天以上的患者比例从 2000 年的 33.5%增加到 2013 年的 60.2%。HIV 感染率最高的是来自高 HIV 流行国家的黑非洲裔人群（32.3%）、药物滥用者（8.1%）和粟粒性或脑膜性结核病患者（17.2%）。
结核病-人类免疫缺陷病毒（HIV）合并感染总体呈下降趋势，同时诊断出两种感染的患者比例也有所下降。然而，在一些结核病患者亚群中，HIV 感染率仍然很高，特别是来自高 HIV 流行国家的黑非洲裔人群和有药物滥用史的人群。目前对所有诊断为结核病的患者进行 HIV 感染检测的政策对于确保结核病患者的适当管理非常重要，但如果在结核病发生之前就能诊断出 HIV，那么其中许多结核病病例是可以预防的。改善对潜伏性结核病和 HIV 的筛查，并确保这些人群中 HIV 的早期治疗，可能有助于预防这些结核病病例。英国艾滋病协会关于来自撒哈拉以南非洲地区的 HIV 感染者潜伏性结核病检测的指南仍然适用，对于有药物滥用、无家可归或监禁史的 HIV 感染者，也应考虑进行潜伏性结核病筛查。
