To describe temporal changes in the incidence rate (IR) of tuberculosis (TB) (pulmonary or extrapulmonary) among HIV-positive patients in Western Europe (WE) and risk factors of TB across Europe.
Poisson regression models were used to determine temporal changes in IR of TB among 11,952 patients from WE (1994-2010), and to assess risk factors for TB among 12,673 patients from across Europe with follow-up after 2001.
277 TB events occurred during 84,221 person-years of follow-up (PYFU) in WE. The IR declined from 1.91 (95% confidence interval: 1.51-2.37) in 1994-1995 to 0.12 (0.07-0.21) /100 PYFU in 2002-2003, and remained stable thereafter.After January 2001, 159 TB events were diagnosed; 65 cases in WE and 94 cases in Eastern Europe (EE); resulting in IRs of 0.12 (0.09-0.14) and 0.65 (0.52-0.79)/100 PYFU, respectively. In multivariable analysis, IR of TB was approximately four-fold higher in EE compared with WE (IRR: 4.25 (2.78-6.49); p < 0.001). There were no significant temporal changes after 2001 and risk factors did not differ significantly between EE and WE. Lower CD4 cell counts, higher HIV-RNA levels, male gender, intravenous drug usage and African origin were all associated with higher risk of TB.
IRs of TB in WE remained at a very low and stable level since 2001. After 2001, patients in EE were at substantially higher risk of TB than in WE. TB is of great concern in HIV-positive patients, especially in areas with high TB prevalence, high levels of immigration from TB-endemic regions, and with suboptimal access to combination antiretroviral therapy.