Combining surveillance systems to investigate local trends in tuberculosis-HIV co-infection

ABSTRACT

Alameda County has some of the highest human immunodeficiency virus (HIV) and tuberculosis (TB) case rates of California counties. We identified TB-HIV co-infected patients in 2002–2015 by matching county TB and HIV registries, and assessed trends in TB-HIV case rates and estimated prevalence ratios for HIV co-infection. Of 2054 TB cases reported during 2002–2015, 91 (4%) were HIV co-infected. TB-HIV case rates were 0.29/100,000 and 0.40/100,000 in 2002 and 2015, respectively, with no significant change (P = 0.85). African-American TB case-patients were 9.77 times (95% confidence interval [CI] 5.90–16.17) more likely than Asians to be HIV co-infected, and men 2.74 times (95% CI 1.66–4.51) more likely co-infected than women. HIV co-infection was more likely among TB case-patients with homelessness (6.21, 95% CI 3.49–11.05) and injection drug use (11.75, 95% CI 7.61–18.14), but less common among foreign-born and older case-patients (both P < 0.05). Among foreign-born case-patients, 42% arrived in the U.S. within 5 years of TB diagnosis. TB-HIV case rates were low and stable in Alameda County, and co-infected patients were predominantly young, male, U.S.-born individuals with traditional TB risk factors. Efforts to reduce TB-HIV burden in Alameda County should target persons with traditional TB risk factors and recently arrived foreign-born individuals.

KEYWORDS:

• Tuberculosis
• HIV
• AIDS-related opportunistic infections
• public health surveillance
• California

Acknowledgements

The authors would like to thank Richard Lechtenberg, MPH, and Janet Tang, Ph.D. for their contributions.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Thibaut Davy-Mendez http://orcid.org/0000-0002-8505-9268