title: Impact of the human immunodeficiency virus on the epidemiology of tuberculosis in area 15 of the Valencian community in Spain.
abstract: METHODS
  Area 15 in Valencia.
  
  
  OBJECTIVE
  To describe the epidemiology (1987-2001) of tuberculosis (TB) in human immunodeficiency virus (HIV) patients.
  
  
  METHODS
  Study of annual incidence, age distribution, excess cases attributed to HIV, etiological risk fraction (ERF), population attributable fraction (PAF) and f factor.
  
  
  RESULTS
  Of 476 cases diagnosed, 459 were TB, 16 environmental and one mixed; 76% of environmental cases were HIV-positive (P < 0.001). There was a mean annual TB incidence of 24.6/100000, with an annual reduction of 4%. Seventy-three patients were HIV coinfected (16%) (mean incidence 3834/100 000 seropositives). The principal risk factor was drug use (59%) for HIV+ and contact with TB for HIV-. We found no difference in pulmonary or extra-pulmonary location between groups, contrary to mixed cases (P < 0.001). In HIV+ there was a lower frequency of infiltrates (P < 0.001) and cavitation (P < 0.01), and a higher frequency of adenitis (P < 0.001), miliary or nodular pattern and normal X-ray (P < 0.001). Seropositives had a 174 times higher probability of developing TB. The mean ERF attributed to HIV was 99%, the PAF was 16% and the f factor was 1.19. Highly active antiretroviral therapy (HAART) reduced the risk of TB in HIV+ by 80%.
  
  
  CONCLUSIONS
  TB has continued its decline, although HIV generated an excess of cases in the 1990s. HAART has reduced the TB risk in HIV+ and possibly the overall rate of TB.
authors.affiliation: Pneumology Service, Hospital Marina Baixa, Alicante 03570, Spain. calpe_jos@gva.es
authors.forename: J L
authors.initials: JL
authors.lastname: Calpe
authors.forename: E
authors.initials: E
authors.lastname: Chiner
authors.forename: J
authors.initials: J
authors.lastname: Marín-Pardo
authors.forename: J M
authors.initials: JM
authors.lastname: Pardo
authors.forename: A
authors.initials: A
authors.lastname: Calpe
authors.forename: V
authors.initials: V
authors.lastname: Armero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications; D014376:Tuberculosis / Q000453:epidemiology*; D014391:Tuberculosis, Miliary / Q000150:complications / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology