Abstract
Heretofore we have not seen strong evidence of synergy between HIV and tuberculosis (TB) in Canada. This may simply reflect a lack of concurrent surveillance for the two diseases. To date, the goal of universal HIV testing of TB patients (>80% tested) in Canada has not been achieved, despite the existence of two national advisories recommending universal HIV testing of TB patients. In response to these advisories, we recently undertook to demonstrate the feasibility of using an ‘opt-out’ approach to achieve universal HIV testing of TB patients in Alberta — see the Canadian Journal of Public Health 2009;100(2):116–20. In the present commentary, we add two more years of data (2007–2008) to our earlier report and demonstrate for the first time that HIV co-infection is significantly greater in middle-aged (35–64 years) compared to young adult (15–34 years) TB patients and in Aboriginal and sub-Saharan African, compared to Canadian-born non-Aboriginal and foreign-born ‘other’ TB patients. Our findings underscore the need for universal concurrent testing as well as greater interaction between TB and HIV programs.
Key words: Tuberculosis, HIV
Résumé
Nous n’avons pas eu jusqu’à maintenant de preuves solides de l’existence d’une synergie entre le VIH et la tuberculose au Canada. Cela pourrait simplement s’expliquer par l’absence d’une surveillance parallèle des deux maladies. On n’a pas encore atteint au Canada l’objectif du dépistage universel du VIH chez les patients atteints de tuberculose (>80 % de sujets dépistés), malgré deux avis nationaux recommandant le dépistage universel du VIH chez les patients tuberculeux. En réponse à ces avis, nous avons décidé dernièrement de démontrer la faisabilité d’une „ approche d’abstention ” pour obtenir le dépistage universel du VIH chez les patients atteints de tuberculose en Alberta - voir notre article dans la RCSP, vol. 100, no 2 (2009), p. 116–120. Dans le présent commentaire, nous ajoutons deux autres années de données (2007–2008) à notre rapport antérieur et nous démontrons pour la première fois que la co-infection par le VIH est significativement plus élevée chez les patients tuberculeux d’âge moyen (35 à 64 ans) que chez les jeunes adultes (15 à 34 ans), et chez les patients tuberculeux autochtones et originaires d’Afrique sub-saharienne que chez les patients non-autochtones nés au Canada ou ailleurs qu’en Afrique sub-saharienne. Ces résultats soulignent le besoin d’un dépistage universel parallèle et d’une plus grande interaction entre les programmes de lutte contre la tuberculose et le VIH.
Mots clés: tuberculose, VIH
Footnotes
Source of funding: Supported by a grant from the University of Alberta Hospital Foundation.
Conflict of Interest: None to declare.
References
- 1.Tuberculosis in Canada 2006. Public Health Agency of Canada. 2008. [Google Scholar]
- 2.Canadian Thoracic Society, Tuberculosis Directors of Canada, Department of National HealthWelfare in consultation with the provincialterritorial epidemiologists, AIDS coordinatorsHIV caregivers. Guidelines for the identification, investigation and treatment of individuals with concomitant tuberculosis and HIV infection. CCDR. 1992;18:155–60. [PubMed] [Google Scholar]
- 3.The Canadian Tuberculosis Committee of the Centre for Infectious Disease PreventionControl, PopulationPublic Health Branch, Health Canada. Recommendations for screening and prevention of tuberculosis in patients with HIV and for screening for HIV in patients with tuberculosis and their contacts. CCDR. 2002;28(ACS-7):1–6. [PubMed] [Google Scholar]
- 4.Jayaraman G, Preiksaitis J, Larke B. Mandatory reporting of HIV infection and opt-out prenatal screening for HIV infection: Effect on testing rates. CMAJ. 2003;168:679–82. [PMC free article] [PubMed] [Google Scholar]
- 5.World H O U N P f HIV/AIDS H programme. Strengthening health services to fight HIV/AIDS. Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva, Switzerland: WHO; 2007. [Google Scholar]
- 6.Pope DS, DeLuca AN, Kali P, Hausler H, Sheard C, Hoosian E, et al. A cluster randomized trial of provider initiated (Opt-out) HIV counselling and testing of tuberculosis patients in South Africa. J Acquir Immune Defic Syndr 2008;48:190–95. [DOI] [PMC free article] [PubMed]
- 7.Can J Public Health. 2009.
- 8.Frieden TR, Das-Douglas M, Kellerman SE, Henning KJ. Applying public health principles to the HIV epidemic. N Engl J Med. 2005;353:2397–402. doi: 10.1056/NEJMsb053133. [DOI] [PubMed] [Google Scholar]
- 9.Public Health Agency of Canada. HIV/AIDS Epi Updates, November, 2007. 2007. [Google Scholar]
- 10.Canadian Tuberculosis Standards . The Canadian Lung Association and the Public Health Agency of Canada, Ottawa. 6th 2007. [Google Scholar]
- 11.Alberta Health and Wellness. Provincial Program Development and Disease Control. 2008.
- 12.Grosskurth H, Gray R, Hayes R, Mabey D, Wawer M. Control of sexually transmitted diseases for HIV-1 prevention: Understanding the implications of the Mwanza and Rakai trials. Lancet. 2000;355:1981–87. doi: 10.1016/S0140-6736(00)02336-9. [DOI] [PubMed] [Google Scholar]
- 13.Buvé A, Bishikwabo-Nsarhaza K, Mutangadura G. The spread and effect of HIV-1 infection in sub-Saharan Africa. Lancet. 2002;359:2011–17. doi: 10.1016/S0140-6736(02)08823-2. [DOI] [PubMed] [Google Scholar]
- 14.Zencovich M, Kennedy K, MacPherson DW, Gushulak BD. Immigration medical screening and HIV infection in Canada. Int J STD and AIDS. 2006;17:813–16. doi: 10.1258/095646206779307469. [DOI] [PubMed] [Google Scholar]
- 15.Global Tuberculosis Control. WHO Report 2008. 2010. [Google Scholar]
- 16.Larkin J, Flicker S, Koleszar-Green R, Mintz S, Dagnino M, Mitchell C. HIV risk, systemic inequities, and Aboriginal youth. Widening the circle for HIV prevention programming. Can J Public Health. 2007;98:179–82. doi: 10.1007/BF03403708. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Health Canada. Research on HIV/AIDS in Aboriginal people: A background paper. Winnipeg, MB: Health Canada and University of Manitoba; 1998. [Google Scholar]
- 18.Cargill VA. Stone VE. HIV/AIDS: A minority health issue. Med Clin N Am. 2005;89:895–912. doi: 10.1016/j.mcna.2005.03.005. [DOI] [PubMed] [Google Scholar]
- 19.Diaz T, Chu SY, Buehler JW, Boyd D, Checko PJ, Conti L, et al. Socioeconom-ic differences among people with AIDS: Results from a multi-state surveillance project. Am J Prev Med 1994;10:217–22. [PubMed]
- 20.Wang F-L, Larke B, Gabos S, Hanrahan A, Schopflocher D. Potential factors that may affect acceptance of routine prenatal HIV testing. Can J Public Health. 2005;96:60–64. doi: 10.1007/BF03404020. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Plitt S, Singh A, Lee B, Preiksaitis J. HIV seroprevalence among women opting out of prenatal HIV screening in Alberta, Canada: 2002–2004. CID. 2007;45:1640–43. doi: 10.1086/523730. [DOI] [PubMed] [Google Scholar]
- 22.Schreibman T, Friedland G. Human immunodeficiency virus infection prevention: Strategies for clinicians. CID. 2003;36:1171–76. doi: 10.1086/374359. [DOI] [PubMed] [Google Scholar]