Incidence and mortality of tuberculosis disease in Spain between 1997 and 2010: Impact of human immunodeficiency virus (HIV) status

Objective: To estimate incidence and mortality of TB disease in Spain, as well as TB recurrence and its mortality, and to analyse its trend from 1997 to 2010 in human immunodeficiency virus ( HIV)-infected patients (HIV(+) group), compared to HIV-uninfected subjects ( HIV(-) group). Methods: We performed a retrospective study using data from Minimum Basic Data Set. The outcome variables were new TB diagnosis, TB recurrences, and mortality; which were analysed through three calendar periods related to widespread use of combination antiretroviral therapy (cART): a) From 1997 to 1999 for early-period cART; b) from 2000 to 2003 for mid-period cART; and c) from 2004 to 2008 for late-period cART. Results: We studied 86,093 HIV-uninfected patients and 17,031 HIV infected patients. TB diagnosis in HIV(-) group (events per 100,000 patients-yr) decreased from 20.16 ( 1997-1999) to 16.31 (2000-2003; p < 0.001), and later to 13.48 (2004-2010; p < 0.001); and among HIV( +) group ( events per 1000 patients-yr) it decreased from 19.23 ( 1997-1999) to 10.93 ( 2000-2003; p < 0.001), and later to 6.35 (2004-2010; p < 0.001). For the mortality, HIV(-) group (events per 1,000,000 patients-yr) decreased from 11.5 (1997-1999) to 9.8 (2000-2003; p < 0.001), and later to 7.2 (2004-2010; p < 0.001); and HIV(+) group (events per 10,000 patients-yr) decreased from 20.69 (1997-1999) to 13.20 (2000-2003; p < 0.001), and later to 6.83 (2004-2010; p < 0.001). During the whole period, the diagnostic rate and mortality of TB remained 100-fold higher in HIV(+) group than HIV(-) group ( p < 0.001). Moreover, HIV (+) group had higher percentage of patients with TB recurrence than HIV(-) group ( p < 0.001). Conclusion: TB diagnosis and mortality decreased in Spain between 1997 and 2010, in both HIV infected patients and people without HIV infection; but these rates remained higher in HIV infected patients. (C) 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.