Prevalence of M. tuberculosis infection and tuberculosis disease among HIV-infected people in Spain.
OBJECTIVE
To study the prevalence of Mycobacterium tuberculosis infection (MTBI) and past/current tuberculosis (TB) among human immunodeficiency virus (HIV) infected persons in Spain.


METHODS
Longitudinal study conducted between 2000 and 2003 at 10 HIV hospital-based clinics. Data were drawn from clinical records. Associations were measured using odds ratios (ORs) and their 95% confidence intervals (95%CI).


RESULTS
Of the 1242 persons who met the eligibility criteria, most were male (75%), aged <40 years (75%) and unemployed (40%). HIV infection occurred through intravenous drug use (53%), heterosexual sex (29%) and sex between men (16%). In the initial evaluation, 315 subjects had evidence of MTBI: 84 (6.8%) had a history of TB, 23 (1.8%) current TB and 208 (16.8%) latent tuberculosis infection (LTBI). MTBI was associated with male sex, age 30-49 years, contact with a TB case, homelessness, poor education, and negatively with CD4 <100 cells/mm(3). Among subjects with MTBI, past/current TB was associated with retirement/disability (OR 6, 95%CI 1.6-22.5), CD4 <200 cells/mm(3) (OR 9.7, 95%CI 3.8-24.6), viral load >55,000 copies (OR 5.3, 95%CI 1.4-20.0), and negatively, with skilled work (OR 0.4, 95%CI 0.1-1.0) or administrative/managerial/professional work (OR 0.05, 95%CI 0.01-0.4).


CONCLUSIONS
Social context has an impact on the effectiveness of HIV and TB control programmes even in industrialised countries with free access to health care.
Diez
M
M
Instituto de Salud Carlos III, Unidad de Epidemiología del VIH/Sida, Madrid, Spain. mdiez@isciii.es
Diaz
A
A
Bleda
M J
MJ
Aldamiz
M
M
Camafort
M
M
Camino
X
X
Cepeda
C
C
Costa
A
A
Ferrero
O
O
Geijo
P
P
Iribarren
J A
JA
Moreno
S
S
Moreno
M E
ME
Labarga
P
P
Pinilla
J
J
Portu
J
J
Pulido
F
F
Rosa
C
C
Santamaria
J M
JM
Telenti
M
M
Trapiella
L
L
Trastoy
M
M
Viciana
P
P
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*