HIV-Prevalence in Tuberculosis Patients in Germany, 2002–2009: An Estimation Based on HIV and Tuberculosis Surveillance Data

Abstract

Tuberculosis (TB) and HIV comorbidity is a major challenge in TB prevention and control but difficult to assess in Germany as in other countries, where data confidentiality precludes notifying the HIV status of TB patients. We aimed to estimate the HIV-prevalence in TB patients in Germany, 2002–2009, and to characterize the HIV/TB patients demographically. Data from the long-term observational open multicentre cohort ClinSurv HIV were used to identify incident TB in HIV-positive individuals. We assessed the cohort’s coverage for the nationwide HIV-positive population by contrasting ClinSurv HIV patients under antiretroviral therapy (ART) with national HIV patient numbers derived from ART prescriptions (data by Insight Health; available for 2006–2009). The HIV-prevalence in TB patients was calculated as the number of HIV/TB cases projected for Germany over all culture-positive TB notifications. From 2002 to 2009, 298 of 15,531 HIV-positive patients enrolled in the ClinSurv HIV cohort were diagnosed with TB. A 21% cohort coverage was determined. The annual estimates of the HIV-prevalence in TB patients were on average 4.5% and ranged from 3.5% (95%CI 2.3–5.1%) in 2007 to 6.6% (95%CI 5.0–8.5%) in 2005. The most recent estimate for 2009 was 4.0% (95%CI 2.6–5.9%). The 298 HIV/TB patients were characterized by a male-to-female ratio of 2.1, by a median age of 38 years at TB diagnosis, and by 59% of the patients having a foreign origin, mainly from Subsahara Africa. We provide, to our knowledge, the first estimate of the HIV-prevalence in TB patients for Germany by joint evaluation of anonymous HIV and TB surveillance data sources. The identified level of HIV in TB patients approximates available surveillance data from neighbouring countries and indicates a non-negligible HIV/TB burden in Germany. Our estimation approach is valuable for epidemiological monitoring of HIV/TB within the current legal frameworks.

Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil

“…Regarding sociodemographic characteristics, this study confirmed the results of previous research [27,28]. The profile of the co-infected individual is a white males with a low level of education and a mean age of 38 ± 9,91 years.…”

TB or not TB? Diagnostic difficulties in HIV-positive versus HIV-negative tuberculosis patients with an immigration background in Germany

“…To every TB patient HIV diagnostics should be offered since HIV co-infection may present particular problems. 2,10,16 To our initial surprise TB was recognized earlier in HIV+ patients analogous to an observation confirmed by two recent studies from the UK. 22,23 Explanations may be that in HIV+ patients infectious diseases are considered earlier, that the treating doctor is experienced with infectious diseases, that paucibacillary cases are less frequent, that consequently PCR less frequently yield false negative results, that the clinical course is more acute, and that pulmonary manifestations are more common.…”

“…This anticipates an increase of both TB and HIV patients in immigrants to Germany. 1,3,9–13 Furthermore, extrapulmonary TB, which appears to affect more often in female patients, might also increase. 14 Both infections, TB and HIV, need to be recognized early, to avoid further spread to the population and mismanagement of the individual patient.…”

Higher Rate of Tuberculosis in Second Generation Migrants Compared to Native Residents in a Metropolitan Setting in Western Europe

“…Our study aimed to investigate the frequency of tuberculosis in subpopulations, but it does not allow for estimating risk at the individual level given that individuals may be heterogeneous in terms of other risk factors for tuberculosis, e.g. socio-economic determinants, risk behaviour such as smoking and alcohol or drug abuse, or HIV co-infection [ 33 ]. Further, sample size did not allow us to stratify the rate of tuberculosis in immigrants by different countries or areas of origin.…”