Pulmonary and extrapulmonary tuberculosis at AIDS diagnosis in Spain: epidemiological differences and implications for control.

OBJECTIVE

To ascertain the differential factors associated with pulmonary versus extrapulmonary tuberculosis (TB) at AIDS diagnosis in Spain.

DESIGN

Analysis of AIDS surveillance data.

METHODS

Data about AIDS patients, aged 12 years and over, diagnosed in 1995 were taken from the Spanish AIDS Register. The respective proportions of cases presenting with pulmonary and extrapulmonary TB at AIDS diagnosis were analysed by gender, age, HIV transmission category, prison record, province, country of origin and CD4+ lymphocyte count. A multivariate analysis was carried out using logistic regression analysis.

RESULTS

Of 6161 AIDS cases analysed, 20.1% presented with pulmonary TB and 20.4% with extrapulmonary TB. Overall, TB showed association with men, age under 30 years, injecting drug users (IDU), cases of heterosexual HIV transmission, and concurrent or past stay in prison. Frequency of TB proved no different among foreign-born patients. Pulmonary and extrapulmonary TB showed a similar distribution for most of the variables. Current prison inmates registered a high risk of pulmonary TB [adjusted odds ratio (OR), 4.2; 99% confidence interval (CI), 3.1-5.8] compared with patients without prison record, and ex-prison inmates registered an intermediate risk (OR, 2.3; 99% CI, 1.8-3.0). Among patients with TB at AIDS diagnosis, pulmonary TB was associated with subjects currently in prison (OR, 2.1; 99% CI, 1.5-3.0) and injecting drug use (OR, 1.5; 99% CI, 1.0-2.4). Pulmonary TB presented with higher CD4+ lymphocyte counts than extrapulmonary TB (P < 0.001).

CONCLUSIONS

The results suggest the importance that recent transmission of TB may be having among young adults, IDU and prison inmates in particular, and calls for a review of control strategies.