Winter, Joanne Rebecca; (2018) HIV and tuberculosis co-infection in England, Wales and Northern Ireland: Prevalence, risk factors and transmission. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

In high-income countries, HIV and tuberculosis are concentrated in hard-to-reach populations. The epidemiology of HIV and tuberculosis co-infection has not been recently described in the UK, and the role of HIV in tuberculosis transmission in low-burden settings is unclear. A systematic review of risk factors for latent tuberculosis infection and active tuberculosis disease was undertaken. The national surveillance datasets for HIV and tuberculosis were linked, and these datasets were used to investigate risk factors for developing tuberculosis for people living with HIV, and to describe trends in HIV co-infection among tuberculosis patients. Strain typing data on Mycobacterium tuberculosis complex isolates from tuberculosis patients were used to examine the role of HIV in tuberculosis transmission. In England, Wales and Northern Ireland, 6.0% of people diagnosed with HIV between 2000 and 2014 had a tuberculosis diagnosis during this time period, and 5.4% of tuberculosis patients were co-infected with HIV. The number and proportion of tuberculosis patients co-infected with HIV declined from 2005 to 2014. The strongest risk factors for tuberculosis among people with HIV were black African ethnicity, birth in a country with high tuberculosis incidence, and HIV acquisition through injecting drug use. High CD4 count and initiating anti-retroviral therapy were both highly protective against tuberculosis. Among tuberculosis patients, drug misuse was the only social risk factor associated with HIV co-infection. Tuberculosis patients with HIV had fewer subsequent clustered cases than HIV-negative tuberculosis patients, and tuberculosis patients with HIV were more often the result of reactivation of latent tuberculosis than recent infection. Co-infection with tuberculosis and HIV has declined, but further reductions are necessary. Increasing screening for HIV and latent tuberculosis in high-risk populations such as people of black African ethnicity, people born in high-incidence countries, and people who inject drugs, could reduce tuberculosis in people living with HIV.

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