An estimate of the contribution of HIV infection to the recent rise in tuberculosis in England and Wales. (Original Article)

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Date: May 2002
From: Thorax(Vol. 57, Issue 5)
Publisher: BMJ Publishing Group Ltd.
Document Type: Article
Length: 3,079 words

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Background: The number of patients with tuberculosis has been increasing slowly in England and Wales since the late 1980s. HIV infection has been a contributory factor to increases in tuberculosis in a number of comparable industrialised countries. This study investigated the extent of tuberculosis and HIV co-infection in England and Wales in 1993 and 1998, and estimated its contribution to the increase in tuberculosis observed during this period.

Methods: Patients aged 16-54 years old at diagnosis on the 1993 and 1998 National Tuberculosis Survey databases were matched with those on the HIV/AIDS patient database. A coded process maintained patient confidentiality. Primary outcome measures were the increase between 1993 and 1998 in the numbers with both infections reported and an estimate of the proportion of the increase in tuberculosis during this period attributable to HIV co-infection.

Results: In 1993 61 (2.2%) tuberculosis patients aged 16-54 years matched with patients reported to the HIV database, increasing to 112 (3.3%) in 1998 (p=0.08 OR 1.35; 95% Cl 0.97 to 1 .87). Patients co-infected with HIV contributed an estimated 8.5% of the increase in number of tuberculosis patients between 1993 and 1998 nationwide (11% in London). In both years prevalence of co-infection was greatest in London and in patients of white and black African ethnic groups.

Conclusions: In 1998 the number of tuberculosis patients co-infected with HIV in England and Wales, though still small, had nearly doubled since 1993, with most of the increase occurring in London. As HIV infection may be undiagnosed in patients with tuberculosis, and tuberculosis may be unreported in patients with diagnosed HIV infection, the true extent of co-infection will have been underestimated by this study. In addition, constraints in coded matching make it inevitable that some reported co-infections are missed. Routine HIV testing of all patients with tuberculosis should now be considered, particularly in patients of white or black African ethnic origin under 55 years of age.


The association between HIV infection and tuberculosis is well established (4-8) and, in many countries, the HIV epidemic has played a large part in the rise of tuberculosis. (7) Although some estimates have been made previously on local (9-11) as well as national (2 12) prevalence of co-infection in England and Wales, it is not known to what extent HIV infection has contributed to the most recent national increase in tuberculosis. We examined this by investigating the extent of the overlap of tuberculosis (as reported to the 1993 and 1998 national surveys) and HIV infection (using diagnosed HIV infections reported to the PHLS CDSC).

Recent routine annual notification data and laboratory reports show rising numbers of patients with tuberculosis in England and Wales, particularly in London (Notification of Infectious Diseases database, Public Health Laboratory Service Communicable Disease Surveillance Centre (PHLS CDSC), 1988-1998; CDSC LabBase data, 1988-1998). Five-yearly national tuberculosis surveys in England and Wales have been carried out since 1978, and the last three surveys (1988, 1993, 1998) have reflected these increases. 1-3


In June 2000, reports on patients in England...

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Gale Document Number: GALE|A86429925