THE SPREAD OF AIDS AND THE REEMERGENCE OF TUBERCULOSIS IN CATALONIA, SPAIN

Objective: To assess the impact of HIV/AIDS on the incidence of tuberc ulosis (TB) and to analyse the determinants of TB presenting as the fi rst indicative disease of AIDS. Design: Analysis of TB and AIDS survei llance data. Setting: Catalonia, north-east Spain. Patients: Two separ ate sources were used: (i) TB cases reported to the Catalan TB registr y diagnosed between January 1982 and December 1993; (ii) AIDS cases re ported to the AIDS Catalan registry diagnosed between January 1982 and December 1994. Main outcome measures: Expected and observed TB cases, and number and characteristics of AIDS cases presenting with TB. Resu lts: From 1987 to 1993 the annual TB crude incidence rate increased by 50% to a rate of 49.7 per 100 000, with at least 60% of the increase directly due to AIDS. During that period specific rates among children aged 0-4 years remained high at around 40 per 100 000. A total of 701 0 AIDS cases were diagnosed between 1988 and 1994, of whom 24.3% had T B. Multivariate analysis from those AIDS cases showed that besides mal e sex, young age, and urban residence, the strongest predictors of TB among AIDS cases were history of imprisonment (odds ratio, 2.16; P < 0 .001) and intravenous drug use (odds ratio, 1.65; P < 0.001). Conclusi ons: The high rates of TB among children and young adults suggest that TB transmission has increased during this period, especially among pe ople al high risk of AIDS. The determinants of individual risk of TB a mong AIDS patients act together, especially in prisons. The HIV/TB coe pidemic is an emerging threat potentially for all and requires expandi ng targeted measures to prevent and control both diseases in our setti ng.