HIV-related tuberculosis in British Columbia: indications of a rise in prevalence and a change in risk groups.

OBJECTIVES

To identify patients with coexisting HIV infection and tuberculosis (TB) and recent trends in prevalence and factors associated with coinfection.

DESIGN

Case review.

PARTICIPANTS

All known patients with TB and HIV infection in British Columbia, in whom TB was diagnosed between 1990 and 1994. This group was compared with those in whom TB was diagnosed between 1984 and 1990.

OUTCOME MEASURES

Patients' demographic characteristics and risk factors for HIV infection, site of TB, occurrence of drug-resistant TB, treatment and outcome.

RESULTS

Forty-four patients with HIV infection and TB were identified, of whom 16% were women, whereas non of those diagnosed from 1984 to 1990 were women, and 14 (32%) were aboriginal Canadians, compared with only 3 (8%) of those diagnosed from 1984 to 1990 (p < 0.01 for both). Forty patients had identifiable risk factors for HIV infection. A smaller proportion of the recent group than of the previous group were homosexual men (excluding those for whom risk factors were not known, 17/33 men [52%] in 1990 to 1994 v. 36/39 [92%] in 1984 to 1990), and a larger proportion were intravenous drug users (22/40 [55%] in 1990 to 1994 v. 8/39 [21%] in 1984 to 1990, p < 0.01 for both). Since 1984 an increasing proportion of patients with TB diagnosed each year have also had HIV infection (linear trend p < 0.001). Drug resistance was not found in any cultures taken at the time of diagnosis; however, rifampin resistance developed 7 months after therapy was initiated in one patient. Of the 40 patients who started therapy, 24 had directly observed therapy. Nine patients died while receiving therapy, and four died without receiving any antituberculous therapy. TB was the cause of death, or a contributing factor to death, in five cases.

CONCLUSIONS

Significantly more intravenous drug users, aboriginal Canadians and women are now presenting with HIV-related TB in British Columbia. All HIV-positive patients need to be evaluated for TB, and HIV infection must be considered in assessing all newly diagnosed TB cases and in screening contacts of active cases, especially if patients have risk factors for HIV infection.