HIV related tuberculosis in the United Kingdom : epidemiology, practice and control

Background: Latent tuberculosis infection (LTBI) reactivation amongst people living with HIV (PLWH) remains significant, despite HIV virological control. Methods: Four studies were undertaken. A UK survey of HIV clinicians determined current LTBI screening practice in PLWH. An evaluation of the Leicester HIV cohort defined overall risk of active TB amongst PLWH, and risk factors for incident TB. A patient questionnaire cohort study examined attitudes and planned behaviour towards LTBI screening/treatment amongst PLWH and correlated these with actual screening outcomes. Finally, systematic LTBI screening/treatment of the entire Leicester HIV cohort defined LTBI risk factors and assessed feasibility of programmatic screening. Results: National LTBI screening practices were heterogeneous and offered by 57.4% HIV centres; this was not congruent with local TB-HIV burden. 325/2158 (15.1%) of the Leicester HIV cohort had had active TB; 100/325 (30.8%) was incident TB occurring more than 3 months after HIV diagnosis, with incidence rate 4.47/1000 person years. Incident TB risk and the time taken to develop incident TB were significantly associated with TB incidence in the country of birth (p < 0.0001). There was overwhelming ... (continues)