Abstract
OBJECTIVE: Prior to the introduction of highly active antiretroviral therapy (HAART), active tuberculosis (TB) was a major contributor to HIV-related morbidity and mortality in Canada and other low-incidence regions. We performed this study to examine TB incidence, clinical manifestations and screening uptake in HIV-infected TB patients during the era of HAART therapy.
METHODS: We performed a retrospective study on all HIV-infected TB patients in British Columbia over a 10-year period (2003–2012). Demographic and clinical characteristics were extracted along with screening and treatment outcomes. Trends in provincial TB incidence, HIV testing and HAART prevalence were also examined.
RESULTS: In total, 2,839 TB cases were identified in BC during this period, including 129 HIV-infected TB patients. Surprisingly, only 64 HIV-infected TB patients (50%) had a documented screening tuberculin skin test (TST) prior to TB diagnosis. Of the 39 HIV-infected TB patients with prior TST positivity, 38 (97.4%) had not completed a course of isoniazid preventive therapy. TB incidence decreased significantly in the HIV-infected population of BC over the study period, from 1.9 to 0.5 TB cases per 1,000 HIV-infected individuals (p<0.001).
CONCLUSION: The incidence of HIV-TB decreased significantly over the past decade despite suboptimal latent TB infection screening and prevention practices. This decrease in TB incidence is likely attributable to the increased uptake of HAART. Consideration should be given to intensifying prevention efforts to accelerate TB elimination in HIV-infected populations in low-incidence regions.
Key Words: Tuberculosis, tuberculin test, latent tuberculosis, anti-retroviral agents, HIV
Résumé
OBJECTIF : Avant l’avènement de la thérapie antirétrovirale hautement active (TAHA), la tuberculose progressive était l’un des principaux facteurs de morbidité et de mortalité liées au VIH au Canada et dans d’autres régions à faible incidence. Notre étude visait à examiner l’incidence de la tuberculose, ses manifestations cliniques et le recours au dépistage chez les patients tuberculeux infectés par le VIH à l’ère de la TAHA.
MÉTHODE : Nous avons mené une étude rétrospective de tous les patients tuberculeux infectés par le VIH en Colombie-Britannique sur une période de 10 ans (2003–2012). Nous avons extrait leurs caractéristiques démographiques et cliniques, ainsi que les données sur le dépistage et les effets du traitement. Nous avons aussi examiné les tendances de l’incidence de la tuberculose, du dépistage du VIH et de la prévalence de la TAHA dans la province.
RÉSULTATS : En tout, 2 839 cas de tuberculose ont été signalés en C.-B. au cours de la période, dont 129 patients tuberculeux infectés par le VIH. Étonnamment, seuls 64 patients tuberculeux infectés par le VIH (50 %) avaient subi un test cutané à la tuberculine (TCT) consigné en dossier avant leur diagnostic de tuberculose. Sur les 39 patients tuberculeux infectés par le VIH ayant eu un TCT positif au préalable, 38 (97,4 %) n’avaient pas suivi un traitement préventif complet à l’isoniazide. L’incidence de la tuberculose a considérablement diminué dans la population infectée par le VIH en C.-B. au cours de la période de l’étude, passant de 1,9 à 0,5 cas de tuberculose pour 1 000 personnes infectées par le VIH (p<0,001).
CONCLUSION : L’incidence de la comorbidité VIH-tuberculose a considérablement diminué au cours de la dernière décennie malgré les pratiques sous-optimales de prévention et de dépistage de la tuberculose latente. Cette incidence réduite de la tuberculose est probablement imputable au recours accru à la TAHA. Il faudrait envisager d’intensifier les efforts de prévention afin d’accélérer l’élimination de la tuberculose au sein des populations infectées par le VIH dans les régions à faible incidence.
Mots Clés: tuberculose, test tuberculinique, tuberculose latente, antirétroviraux, VIH
Footnotes
Conflict of Interest: Dr. Montaner is supported by the British Columbia Ministry of Health and by the US National Institutes of Health (R01DA036307). He has also received limited unrestricted funding from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. Other authors have no conflicts of interest to declare.
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