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1 Dipartimento di Epidemiologia, and 2 Dipartimento Clinico, Istituto Nazionale per le Malattie Infettive "L. Spallanzani" – IRCCS, Rome, 3 Clinica Malattie Infettive e Tropicali, Università di Brescia, Brescia, 4 III Divisione di Malattie Infettive, Ospedale "L. Sacco", Milano, 5 Divisione di Malattie Infettive, Arcispedale S. Anna, Ferrara, 6 Divisione di Malattie Infettive B, Ospedale Amedeo di Savoia, Torino, and 7 Istituto di Malattie Infettive, Università di Perugia, Perugia, Italy. 8 StopTB Dept (STB), World Health Organization, Geneva, Switzerland
CORRESPONDENCE: E. Girardi, Dipartimento di Epidemiologia, Istituto Nazionale per le Malattie Infettive "L. Spallanzani" – IRCCS, via Portuense, 292–00149 Roma, Italy. Fax: 39 065582825. E-mail: girardi@inmi.it
Keywords: Antiretroviral therapy, epidemiology, HIV infection, Italy, multicentre study, tuberculosis
Received: September 26, 2003
Accepted March 23, 2004
This work was financially supported by Ministero della Salute-Progetto AIDS-ISS grant 50.A.0.20 and Fondi per la Ricerca Corrente degli IRCCS.
Highly active antiretroviral therapy (HAART) greatly reduces the risk of developing tuberculosis for HIV-infected persons. Nonetheless, HIV-associated tuberculosis continues to occur in countries where HAART is widely used.
To identify the characteristics of HIV-infected persons who develop tuberculosis in the context of the availability of HAART, the current authors analysed data taken from 271 patients diagnosed, in Italy, during 1999–2000. These patients represent 0.7% of the 40,413 HIV-infected patients cared for in the clinical units participating in this current study.
From the data it was observed that 20 patients (7.4%) had a previous episode of tuberculosis whose treatment was not completed. Eighty-one patients (29.9%) were diagnosed with HIV at tuberculosis diagnosis, 108 (39.8%) were aware of their HIV status but were not on antiretroviral treatment and 82 (30.3%) were on antiretroviral treatment. Patients on antiretroviral treatment were significantly less immunosuppressed than patients with HIV diagnosed concurrently with tuberculosis, or other patients not on antiretrovirals (median CD4 lymphocytes count: 220 cells·mm–3 versus 100 cells·mm–3, and 109 cells·mm–3, respectively). No significant differences in clinical presentation of tuberculosis according to antiretroviral therapy status were recorded.
Failure of tuberculosis control interventions (e.g. noncompletion of treatment) and of HIV care (delayed diagnosis of HIV infection and suboptimal uptake of therapy) may contribute to continuing occurrence of HIV-associated tuberculosis in a country where highly active antiretroviral therapy is largely available. However, a significant proportion of cases occur in patients who are on antiretroviral treatment.
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