Journal Article

Changing Sociodemographic and Clinical Characteristics of Tuberculosis among HIV-Infected Patients, New York City, 1992–2005

Tiffany G. Harris, Jiehui Li, David B. Hanna and Sonal S. Munsiff

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 11, pages 1524-1531
Published in print June 2010 | ISSN: 1058-4838
Published online June 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/652654
Changing Sociodemographic and Clinical Characteristics of Tuberculosis among HIV-Infected Patients, New York City, 1992–2005

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Background. Although highly active antiretroviral therapy (HAART) has decreased human immunodeficiency virus (HIV)-related morbidity, tuberculosis remains an important disease among HIV-infected individuals.

Methods. By use of surveillance data, sociodemographic and clinical changes among HIV-infected and HIV-uninfected tuberculosis patients in New York City were evaluated using the Cochran-Armitage trend test and multivariate logistic regression across 3 periods: 1992–1995 (pre-HAART), 1996–2000 (early HAART), and 2001–2005 (late HAART).

Results. Among tuberculosis patients with known HIV status, 4345 (60%) of 7224 were HIV-infected in pre-HAART, 1943 (33%) of 5933 in early HAART, and 851 (22%) of 3815 in late HAART (P<.001 for trend). During the study period, the age of HIV-infected tuberculosis patients increased, and greater proportions were female, non-Hispanic black, Asian, and foreign born; the proportion that was non-Hispanic white decreased. The proportion that was culture-negative for Mycobacterium tuberculosis increased (from 7% pre-HAART to 21% late HAART; P<.001 for trend; early HAART vs pre-HAART adjusted odds ratio [aOR], 1.68; 95% confidence interval [CI], 1.38–2.04), and the proportion with extrapulmonary disease also increased (from 32% to 46%; P<.001 for trend). The proportion with multidrug-resistant tuberculosis decreased (from 16% to 4%; P<.001 for trend), especially from pre-HAART to early HAART (aOR, 0.31; 95% CI, 0.25–0.40). The proportion who died before tuberculosis treatment decreased (from 12% to 7%), and the proportion who died during tuberculosis treatment also decreased (from 29% to 11%) (both, P<.001 for trend). Over time, HIV-infected tuberculosis patients had AIDS longer before the diagnosis of tuberculosis (P<.001 for trend). Similar trends for culture, site of disease, and drug resistance were seen for HIV-uninfected tuberculosis patients.

Conclusions. The sociodemographic and clinical characteristics changed substantially among HIV-infected tuberculosis patients in New York City. Awareness of these changes may speed diagnosis of tuberculosis. Future studies should evaluate HAART's effect on tuberculosis presentation among HIV-infected patients.

Journal Article.  4118 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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