title: Timely HIV diagnosis and HIV/TB comanagement among California patients in 2008.
abstract: OBJECTIVE
  National guidelines highlight the roles of early HIV diagnosis and effective comanagement for HIV and tuberculosis (TB) to prevent mortality and morbidity from HIV-related TB. We assessed HIV diagnosis timing and HIV/TB comanagement for California HIV/TB patients.
  
  
  METHODS
  We reviewed and analyzed public health charts for California HIV/TB patients reported during 2008. HIV diagnoses fewer than three months before TB diagnosis were considered new HIV diagnoses. We determined the proportion of patients with new HIV diagnoses, risk factors for new HIV diagnoses, and proportion of patients receiving recommended CD4 cell count measurements, supervised TB therapy, and antiretroviral therapy (ART).
  
  
  RESULTS
  Of 130 HIV/TB patients, 51% had new HIV diagnoses. Foreign-born patients were more likely than U.S.-born patients to have new HIV diagnoses. Supervised TB therapy and CD4 cell count measurements followed national recommendations for 91% and 74% of patients, respectively. At least 73% of patients started ART before completing TB therapy. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses started ART later and had lower CD4 cell counts and higher viral loads at TB diagnosis.
  
  
  CONCLUSIONS
  Although most HIV/TB patients received the recommended treatment, half had new HIV diagnoses. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses had greater immunosuppression at TB diagnosis. A new diagnosis indicates that HIV could have been diagnosed earlier and ART or treatment for latent TB infection could have been initiated to prevent TB development.
authors.affiliation: California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA ; Current affiliation: California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Immunization Branch, Richmond, CA.
authors.forename: Darryl
authors.initials: D
authors.lastname: Kong
authors.affiliation: California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA.
authors.forename: James P
authors.initials: JP
authors.lastname: Watt
authors.affiliation: Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Marks
authors.affiliation: California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Flood
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D057210:Delayed Diagnosis; D023801:Directly Observed Therapy; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D055985:Latent Tuberculosis / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D062486:Public Health Surveillance; D018570:Risk Assessment; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents