A study of patients undergoing screening or treatment for tuberculosis at three South London hospitals has revealed unexpectedly high levels of HIV infection among people of Indian origin, and an average HIV prevalence of 11.4% among contacts of TB cases and recent arrivals in the UK. This is more than double previous estimates.
The study, published last week in The Lancet, was carried out by Dr Charlotte Rayner of St George's Hospital and colleagues at St Helier Hospital in Carshalton and Mayday Hospital in Croydon. These hospitals serve one of the areas of the UK with one of the highest concentration of recent migrants to the UK.
Two hundred and two individuals with TB and contacts of TB cases (including recent arrivals in the UK) were tested for HIV. Patients already known to be HIV-positive were excluded from the study.
Patients with tuberculosis who tested positive for HIV-1
African
Indian
White
Other
Total
8/57 (14%)
14/97 (12%)
2/38 (5%)
1/10 (10%)
23/202 (11.4%)
Overall, 4% of new arrivals in the UK screened for TB were HIV-positive. Among all patients, the majority of HIV infections were detected in individuals aged 16-34.
The authors of the study warned that the true co-infection rate in South London may be as high as 17-20% if known HIV-positive individuals diagnosed with tuberculosis are taken into account. Patients with newly diagnosed TB should be encouraged to take an HIV test, propose the authors, and HIV infection should always be considered as a reason for the reactivation of tuberculosis.
Reference
Bowen EF, Rayner CFJ et al. HIV seroprevalence by anonymous testing in patients with Mycobacterium tuberculosis and in tuberculosis contacts. The Lancet 356: 1488-1489, 2000.