title: Tuberculosis in HIV-negative and HIV-infected patients in a low-incidence country: clinical characteristics and treatment outcomes.
abstract: BACKGROUND
  In Switzerland and other developed countries, the number of tuberculosis (TB) cases has been decreasing for decades, but HIV-infected patients and migrants remain risk groups. The aim of this study was to compare characteristics of TB in HIV-negative and HIV-infected patients diagnosed in Switzerland, and between coinfected patients enrolled and not enrolled in the national Swiss HIV Cohort Study (SHCS).
  
  
  RESULTS
  All patients diagnosed with culture-confirmed TB in the SHCS and a random sample of culture-confirmed cases reported to the national TB registry 2000-2008 were included. Outcomes were assessed in HIV-infected patients and considered successful in case of cure or treatment completion. Ninety-three SHCS patients and 288 patients selected randomly from 4221 registered patients were analyzed. The registry sample included 10 (3.5%) coinfected patients not enrolled in the SHCS: the estimated number of HIV-infected patients not enrolled in the SHCS but reported to the registry 2000-2008 was 146 (95% CI 122-173). Coinfected patients were more likely to be from sub-Saharan Africa (51.5% versus 15.8%, P<0.0001) and to present disseminated disease (23.9% vs. 3.4%, P<0.0001) than HIV-negative patients. Coinfected patients not enrolled in the SHCS were asylum seekers or migrant workers, with lower CD4 cell counts at TB diagnosis (median CD4 count 79 cells/µL compared to 149 cells/µL among SHCS patients, P = 0.07). There were 6 patients (60.0%) with successful outcomes compared to 82 (88.2%) patients in the SHCS (P = 0.023).
  
  
  CONCLUSIONS
  The clinical presentation of coinfected patients differed from HIV-negative TB patients. The number of HIV-infected patients diagnosed with TB outside the SHCS is similar to the number diagnosed within the cohort but outcomes are poorer in patients not followed up in the national cohort. Special efforts are required to address the needs of this vulnerable population.
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Fenner
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gagneux
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Janssens
authors.forename: Jan
authors.initials: J
authors.lastname: Fehr
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.forename: Matthias
authors.initials: M
authors.lastname: Hoffmann
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Jacques
authors.initials: J
authors.lastname: Schrenzel
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodmer
authors.forename: Erik C
authors.initials: EC
authors.lastname: Böttger
authors.forename: Peter
authors.initials: P
authors.lastname: Helbling
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D006679:HIV Seropositivity; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D013557:Switzerland; D014171:Transients and Migrants; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology* / Q000821:virology