title: Tuberculosis among HIV-positive patients across Europe: changes over time and risk factors.
abstract: OBJECTIVE
  To describe temporal changes in the incidence rate of tuberculosis (TB) (pulmonary or extrapulmonary) among HIV-positive patients in western Europe and risk factors of TB across Europe.
  
  
  METHODS
  Poisson regression models were used to determine temporal changes in incidence rate of TB among 11,952 patients from western Europe (1994-2010), and to assess risk factors for TB among 12,673 patients from across Europe with follow-up after 2001.
  
  
  RESULTS
  Two hundred and seventy-seven TB events occurred during 84,221 person-years of follow-up (PYFU) in western Europe. The incidence rate declined from 1.91 [95% confidence interval (CI) 1.51-2.37)] in 1994-1995 to 0.12 (0.07-0.21)/100 PYFU in 2002-2003, and remained stable thereafter. After January 2001, 159 TB events were diagnosed; 65 cases in western Europe and 94 cases in eastern Europe; resulting in incidence rates of 0.12 (0.09-0.14) and 0.65 (0.52-0.79)/100 PYFU, respectively. In multivariable analysis, incidence rate of TB was approximately four-fold higher in eastern Europe compared with western Europe [incidence rate ratio (IRR) 4.25 (2.78-6.49), P < 0.001]. There were no significant temporal changes after 2001 and risk factors did not differ significantly between eastern Europe and western Europe. Lower CD4 cell counts, higher HIV-RNA levels, male sex, intravenous drug usage and African origin were all associated with higher risk of TB.
  
  
  CONCLUSIONS
  Incidence rates of TB in western Europe remained at a very low and stable level since 2001. After 2001, patients in eastern Europe were at substantially higher risk of TB than in western Europe. TB is of great concern in HIV-positive patients, especially in areas with high TB prevalence, high levels of immigration from TB-endemic regions, and with suboptimal access to combination antiretroviral therapy.
authors: Copenhagen HIV Programme, University of Copenhagen, Denmark.
authors: Alexey
authors: A
authors: Kruk
authors: Wendy
authors: W
authors: Bannister
authors: Daria N
authors: DN
authors: Podlekareva
authors: Nelly P
authors: NP
authors: Chentsova
authors: Aza G
authors: AG
authors: Rakhmanova
authors: Andrzej
authors: A
authors: Horban
authors: Perre
authors: P
authors: Domingo
authors: Amanda
authors: A
authors: Mocroft
authors: Jens D
authors: JD
authors: Lundgren
authors: Ole
authors: O
authors: Kirk