One-third of people with TB in U.S. unaware of HIV status

Oct 29 2007

Nearly one-third of people living with tuberculosis in the U.S. are unaware of their HIV status, according to a study published Friday in CDC's Morbidity and Mortality Weekly Report, Reuters reports (Dunham, Reuters, 10/25).

The study examined data from the National TB Surveillance System from 1993 to 2005 for 49 states and Washington, D.C. According to the study, reporting of HIV status among people living with TB increased from 35% in 1993 to 68% in 2003 and leveled off during 2004 and 2005 (Marks et al., MMWR, 10/26). Nine percent of all people with active TB in the U.S. tested positive for HIV in 2005. Thirty-one percent of those with TB were unaware of their HIV status in 2005 because they refused testing or were not offered a test, compared with 65% of people living with TB in 1993 (Reuters, 10/25). Groups of people living with TB at an increased risk of acquiring HIV include injection-drug users, noninjection-drug users, homeless people, non-Hispanic blacks, prison inmates and alcohol abusers, according to the report (MMWR, 10/26).

In addition, the report noted that nearly two-thirds of people living with both HIV and TB were black. One in six black TB patients was HIV-positive, compared with one in 20 HIV-positive white TB patients, the report said. "High rates of both HIV infection and TB disease among non-Hispanic blacks emphasize the need in this population to prevent, diagnose early and provide access to care for both conditions," the report said.

According to CDC epidemiologist and report author Suzanne Marks, "HIV increases TB progression, and TB increases HIV progression." She added that the diseases "result in a synergy that can be deadly." The agency recommends routine HIV testing among all people living with TB, according to Reuters. People with HIV/TB coinfection are five times more likely to die during TB treatment than patients who are HIV-negative, according to CDC. "Increased promotion of routine HIV testing and rapid HIV tests might increase acceptability of testing, which would allow health care providers to know the HIV status of a greater percentage of TB patients and enable them to provide optimal care," the report said.

According to CDC, 13,779 TB cases were reported in the U.S. in 2006 -- a decrease of 3% compared with 2005. Of the cases reported in 2006, 57% involved people born outside the country. There were 646 deaths from TB in the U.S. in 2005, CDC said (Reuters, 10/25).

The report is available online.