Quantitative impact of human immunodeficiency virus infection on tuberculosis dynamics.
BACKGROUND
Human immunodeficiency virus (HIV) infection has a major but unquantified impact on the risk of tuberculosis.


OBJECTIVE
To quantify the impact of HIV infection on the number of tuberculosis cases in San Francisco.


METHODS
We studied all patients reported with tuberculosis in San Francisco from 1991 to 2002. The initial isolates of Mycobacterium tuberculosis were genotyped using IS6110 restriction fragment-length polymorphism genotyping as the primary method, and clustered cases (identical genotype patterns) were identified.


RESULTS
We determined the case number, case rate, and the fraction of tuberculosis attributable to HIV infection. Of 2,991 reported tuberculosis cases, 2,193 (73.3%) had a genotype pattern of M. tuberculosis available. Genotypic clusters with at least one HIV-positive person were larger, lasted longer, and had a shorter time between successive cases relative to clusters with only HIV-uninfected persons (P < 0.00005, P = 0.0009, P = 0.018, respectively). Overall, 13.7% of the tuberculosis cases were attributable to HIV infection and an estimated 405 excess tuberculosis cases occurred.


CONCLUSIONS
During a period encompassing the resurgence and decline of tuberculosis in San Francisco, a substantial number of the tuberculosis cases were attributable to HIV infection. Coinfection with HIV amplified the local tuberculosis epidemic.
DeRiemer
Kathryn
K
School of Medicine, University of California, Davis, California 95616, USA. kderiemer@ucdavis.edu
Kawamura
L Masae
LM
Hopewell
Philip C
PC
Daley
Charles L
CL
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016022:Case-Control Studies; D016000:Cluster Analysis; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000635:transmission
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