title: Tuberculosis incidence in HIV/AIDS patients in Israel, 1983-2010.
abstract: OBJECTIVE
  People living with HIV/AIDS (PLWHA) who develop tuberculosis disease are at greater mortality-risk. This study aimed to assess tuberculosis disease incidence among all PLWHA in Israel and identify populations at high-risk for developing tuberculosis.
  
  
  METHODS
  Retrospective cohort-study based on the National HIV and Tuberculosis Registries, which were cross-matched and followed for the last 28-years. PLWHA who developed tuberculosis were compared to those who did not by the Cox-proportional analysis to generate hazard-ratios, and survival-analysis was performed by Log-Rank test.
  
  
  RESULTS
  Of all the 6579 PLWHA reported between 1983 and 2010, corresponding to 55737 person-years, 384 (5.8%) developed tuberculosis. Of those, 14 were Israeli-born and 370 were non-Israeli born. The overall tuberculosis incidence-density was 6.9 cases/1000 person-years (95% CI 1.8-12.0). The cumulative tuberculosis-incidence among PLWHA in 2010 was 586 times higher than in HIV-negative individuals (3400 and 5.8 cases per 100000 population, respectively). Higher hazard-ratios to developing tuberculosis were found in migrant citizens PLWHA who were males, non-Israeli born, those who were diagnosed with HIV/AIDS after 1997, those who originated in high-tuberculosis prevalence country and those who acquired HIV by heterosexual or drug-injection transmission. PLWHA who developed tuberculosis had higher odds of dying than other PLWHA (36.5% and 16.6%, respectively, p<0.001, odds ratio = 2.8, 95% confidence-interval 2.3-3.6). In survival-analysis, time to develop tuberculosis was shorter among males than females, in PLWHA who were reported with HIV after 1997, in heterosexual who originated in high-tuberculosis countries, followed by injecting drug-users, heterosexual from low-tuberculosis burden countries and men who have sex with men.
  
  
  CONCLUSIONS
  Tuberculosis-incidence is higher among non-Israeli born PLWHA, with decreasing trends from 1991. Despite the moderate TB-rate disease among PLWHA, it remains an important cause for severe morbidity and mortality. Tuberculosis in PLWHA reflects mainly the tuberculosis-burden in the originating country and possibly also the mode of HIV-transmission.
authors.affiliation: Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel ; Ramla Department of Health, Ministry of Health, Ramla, Israel.
authors.forename: Zohar
authors.initials: Z
authors.lastname: Mor
authors.forename: Moshe
authors.initials: M
authors.lastname: Lidji
authors.forename: Noa
authors.initials: N
authors.lastname: Cedar
authors.forename: Itamar
authors.initials: I
authors.lastname: Grotto
authors.forename: Daniel
authors.initials: D
authors.lastname: Chemtob
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007557:Israel; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*; D055815:Young Adult