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

Abstract

Patients immigrated or born to immigrated parents constitute an increasing proportion of TB in Germany. This study aimed to assess the clinical presentation and outcome of immigrated TB-monoinfected (TB/HIV-) patients versus TB patients with an HIV coinfection (TB/HIV+). Ninety-three patients (36 boys/men, 57 girls/women; age range, 2-59 years) were investigated of whom 47 were TB/HIV+ and 46 TB/HIV-. The diagnostic delay between first presentation to a doctor and TB diagnosis was long in all cases, especially in TB/HIV-patients (range, 0-336 weeks; median, 8 weeks vs. TB/HIV+ patients; range, 0-288 weeks; median, 0 weeks; P <0.05). TB, especially in young immigrated HIV-patients frequently presents as an atypic extrapulmonary disease, which may end up in a delayed diagnosis of up to several years.

HIV and tuberculosis co-infection among migrants in Europe: A systematic review on the prevalence, incidence and mortality

“…The studies included were published between 2003 and 2016, while the sampling for those studies was conducted between 1984 and 2013. Eight European countries were represented: eleven studies conducted in Spain [ 20 – 30 ], five studies in Italy [ 31 – 35 ], three studies in France [ 36 – 38 ], two studies in Portugal [ 39 , 40 ], Germany [ 41 , 42 ], and United Kingdom (UK) [ 43 , 44 ], and one study in Switzerland [ 45 ] and The Netherlands [ 46 ] ( Table 1 ).…”

“…The main study design was retrospective—eight studies [ 22 – 24 , 28 , 29 , 39 , 40 , 42 ]—followed by six prospective/cohort studies [ 34 , 36 , 37 , 41 , 45 , 46 ] (one of them also multicentric [ 34 ]), two population-based studies [ 31 , 43 ], one quasi-experimental study [ 26 ] and one multicentric study [ 35 ]. The remaining studies did not mention the adopted study design [ 20 , 21 , 25 , 27 , 30 , 32 , 33 , 38 , 44 ] ( Table 1 ).…”

“…The included subjects varied between studies: some studies included patients diagnosed with TB [ 27 , 28 , 32 , 38 – 40 ], HIV/AIDS [ 20 , 24 , 36 , 37 , 41 , 46 ], or HIV-TB co-infection [ 30 , 33 , 34 , 43 ]. Other studies included immigrant patients [ 21 , 35 ], immigrant/foreign-born TB patients [ 26 , 29 , 39 , 42 ], immigrant/foreign-born HIV patients [ 22 , 23 , 25 , 45 , 46 ], and immigrant/foreign-born HIV-TB patients [ 42 ].…”

“…Considering the region of origin, Africa was predominant, with higher percentages of immigrants born in Africa in 10 retrieved studies [ 25 , 30 , 33 , 35 – 37 , 39 , 40 , 42 , 46 ], followed by Latin America [ 20 – 22 , 26 , 27 ], and Western/Eastern Europe [ 38 , 45 ] ( Table 1 ).…”

“…Contradictory results were observed in 3 studies [ 21 , 27 , 32 ]—ranging between 6%-6.8% among migrants vs. 2.3%-37% among nationals ( Table 2 ). Studies including only migrant patients, most conducted in Spain, showed prevalences of HIV-TB co-infection ranging from 1% to 76.6% [ 22 , 23 , 25 , 26 , 29 , 31 , 35 , 42 , 45 , 46 ] ( Table 2 ).…”