Demographic, laboratory and clinical characteristics of HIV-positive tuberculosis cases in Canada.
BACKGROUND
Human immunodeficiency virus (HIV) is an important risk factor for the global incidence and mortality of tuberculosis (TB) and has had a tremendous impact on the epidemiology and the control of the disease. The purpose of this study was to determine the demographic, laboratory and clinical characteristics of HIV-positive TB cases in Canada as compared to HIV-negative cases.


METHODS
TB cases reported to the Canadian TB Reporting System (CTBRS) from 1997 to 2006 were retrospectively reviewed and for those with known HIV serostatus, the distributions of age, sex, country of birth, smear and culture positivity, drug resistance, site of disease and treatment outcome were compared.


RESULTS
2710 TB cases had a report of an HIV test with a 12.9% positivity rate. HIV-positive cases were more likely to be 30-44 years old, male, Canadian born non-Aboriginal or African born. Sputum and lymph node biopsies were significantly more likely to be smear-positive and sputum was more likely to be culture positive. Anti-TB drug resistant rates were similar, except for lower streptomycin resistance in new HIV-positive cases. HIV-positive cases were significantly more likely to present with miliary or central nervous system TB, to have multi-system disease, to have lower treatment success rates (66.4% versus 88.5%) and to have a 5.6 higher case-fatality rate.


CONCLUSIONS
HIV-positive cases have a different demographic profile, present with more advanced and severe forms of disease, have poorer treatment outcomes and higher mortality. All TB cases should be tested for HIV so as to offer appropriate case management and treatment.
Wang
G J
GJ
Anti-Tuberculosis Institute, Henan Provincial Centre for Disease Control and Prevention, 105 Nongye East Road, Zhengdong New District, Zhengzhou, Henan 450016 People's Republic of China.
Phypers
M
M
Ellis
E
E
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002170:Canada / Q000453:epidemiology; D016208:Databases, Factual; D003710:Demography; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D013307:Streptomycin / Q000494:pharmacology; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D013307:Streptomycin