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HIV-associated tuberculosis and immigration in a high-income country: incidence trends and risk factors in recent years

Objective:To examine trends in tuberculosis incidence rates in France during the combination antiretroviral therapy (cART) period. Methods:From the French Hospital Database on HIV, we selected 72 580 patients (including 14 491 migrants) with no history of tuberculosis, followed between 1 January 1997 and 31 December 2008. We then examined incidence rates of tuberculosis and its risk factors. Results:A total of 2625 patients were diagnosed with tuberculosis either at enrolment (N = 932) or during follow-up (N = 1693). During follow-up, the incidence rate of tuberculosis was 0.40/100 patient-years overall, 0.20 among nonmigrants and 1.03 among migrants. Adjusted risk of tuberculosis was 2.01 [95% confidence interval (CI) 1.79–2.26] times higher in migrants than in nonmigrants. The adjusted incidence rate of tuberculosis significantly increased in both migrants and nonmigrants after 2000–2001, with adjusted risks of 2.50 (95% CI 1.54–4.06) and 1.85 (95% CI 1.27–2.69) in 2008 compared with that in 1997, respectively. Other factors independently associated with a higher incidence of tuberculosis were medical follow-up less than or equal to 6 months, no previous antiretroviral therapy, lower CD4 cell count and higher viral load. Nonmigrant patients belonging to HIV-transmission groups other than homosexual men, residing in the Paris area or in French West Indies or with AIDS status were at a supplementary risk. Conclusion:The incidence of tuberculosis is increasing among both migrant and nonmigrant HIV-infected patients in France. This is partly because sub-Saharan African migrants represent an increasing fraction of the HIV-infected population in France and also because of late access to care. Co-prescribing tuberculosis preventive therapy with cART might benefit selected patients, such as migrants and patients with late access to care.