SESSION TITLE: Respiratory Infections Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Introduction of tuberculosis (TB) chemotherapy in the early 1950’s produced a logarithmic decrease in the incidence of TB in the US. The only exception was between 1985 and 1992. Contemporaneous research suggested that the increase in TB, especially non-pulmonary TB (NPTB), was due to the epidemic of HIV occurring at that time. The purpose of this study is to review these findings and assess whether HIV has a continued effect on TB epidemiology.
METHODS: Epidemiological data obtained from the CDC TB Surveillance Program from 1953 through 2011 was analyzed using appropriate linear regression, t-Test and Chi-Squared statistical methods. TB cases with HIV status were analyzed from 1993 to 2010, the period where comprehensive data was available. Results, where appropriate, are reported (mean; 95% CI).
RESULTS: The percentage of total TB cases with known HIV status rose from 29.7% in 1993 to 65.2% in 2010. The percentage of HIV+ patients with TB dropped from 14.66% in 1993 to 5.16% in 2010, while the percentage of TB cases in HIV+ where the HIV status was known decreased from 49.38% to 8.54% in the same period. However, the ratio of PTB to NPTB in patients with known HIV status did not change (4.048; 2.582-5.244). Nor did the ratio of HIV+ to HIV- TB cases (0.983; 0.780 - 1.185). NPTB in HIV + patients as a percentage of total cases where HIV status was known decreased from 7.32% in 1993 to 3.74% in 1997. This decline continued as a slower rate until reaching 1.94% in 2010.
CONCLUSIONS: While the percentage of TB in HIV positive patients decreased, the ratio of HIV+ to HIV- TB cases did not, suggesting most, if not all of the perceived change was due to the change in the percentage of TB cases accurately reporting HIV status. Further, the stable ratio of PTB to NPTB during the period of progressively more effective HIV treatment suggests that, if there is a predisposition for NPTB in HIV+ patients, it is not due to total viral load or measurable immune status. Further specific studies, as well as directed epidemiologic studies are necessary.
CLINICAL IMPLICATIONS: Prompt diagnosis and appropriate management of HIV+ patients have led to a decrease in the incidence of TB infection in this particular population. This improvement was not reflected in the incidence of NPTB. Extra-pulmonary manifestations of TB are rare and declining. However, they are still representing a stable ratio of the total incidence of TB. NPTB should not be discounted based on a measurable immune status or the total viral load.
DISCLOSURE: The following authors have nothing to disclose: Marc Valley, Haytham Adada, Souheil Abdel Nour, Jayant Mehta, Ryland Byrd, Thomas Roy
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