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BACKGROUND: Tuberculosis (TB) infection has major public health implications and is one of the AIDS-defining conditions. It has been shown that TB is a common cause of death for people living with HIV (PLWH). Information regarding TB co-infection is supposed to be captured in the investigation of HIV cases. Pennsylvania regulations require the reporting of TB and HIV cases into a patient-centric electronic reportable disease system. Patients keep the same identifier across all conditions, thus allowing identification of HIV patients co-infected with TB. However, this matching process is currently not routinely done. The purpose of this study is to assess the level of under-recognition of TB infection among PLWH in PA by comparing cases reported with both HIV and TB conditions to TB co-infection as recorded in the HIV investigation records.
METHODS: : All patients in the reportable disease database noted as having active TB, who also had an HIV-related condition, were pulled from the electronic database. All cases occurring between 1992 and 2013 were identified. The HIV records for these cases were then reviewed to see if the HIV record reflected that the patient was co-infected with HIV. A simple percentage analysis was implemented.
RESULTS: There were 536 HIV cases reported between 1992 and 2013 who also had been reported with active TB. Of these, 82 (15.3%) were not recognized as co-infected in the HIV surveillance records. Most of the unrecognized co-infected patients were US-born (including Puerto Rico). There were 51 males and 29 females while the sex of two cases was not reported. By race, 50 cases were African-American, 15 were Hispanic and the rest were white or multi-race. The age of HIV diagnosis in the unrecognized co-infected patients ranged from 25 to 51 years of age. Twenty-three (28.0%) unrecognized co-infected cases are currently dead. Sixty-one (74.4%) of the 82 cases were documented as clinically reviewed while the remaining 21 were classified as either “No Clinical Review or Missing Information on Clinical Review”.
CONCLUSIONS: This assessment demonstrated under-recognition of TB infection in PLWH. TB infection information was not reported in the HIV database even though a clinical review was done on 61 of 82 unrecognized cases. Matching the TB data with the HIV surveillance data is a useful way to obtain new TB infection information for HIV cases. This makes the case for increased collaboration between TB and HIV surveillance programs.