摘要：Objectives. We sought to understand tuberculosis (TB) and HIV coinfection trends in San Diego County, California, and to identify associations between sociodemographic risk factors and TB and HIV coinfection. Methods. We analyzed TB surveillance data from 1993 through 2007. TB cases were grouped by HIV status: positive, negative, or unknown. We used Poisson regression to estimate trends and tested associations between TB and HIV coinfection and sociodemographic risk factors with polychotomous logistic regression. Results. Of 5172 TB cases, 8.8% were also infected with HIV. Incidence of coinfected cases did not change significantly over the period studied, but the proportion of cases among Hispanics increased significantly, whereas cases among non-Hispanic Whites and Blacks decreased. TB cases with HIV coinfection were significantly more likely to be Hispanic, male, injection drugs users, and aged 30 to 49 years, relative to cases with TB disease only. Conclusions. The burden of TB and HIV in San Diego has shifted to Hispanics in the last decade. To address this health disparity, binational TB and HIV prevention efforts are needed. HIV is a potent risk factor for tuberculosis (TB) disease. HIV increases the risk of latent TB infection reactivation, the rate of disease progression, and the risk of new infections by an order of magnitude. 1 TB disease also accelerates HIV disease progression, increasing infectivity and reducing HIV treatment efficacy. 2 The synergy of TB and HIV has created a worldwide public health crisis 1 , 3 , 4 and has significantly complicated attempts to eliminate TB in both the industrialized and developing worlds. 3 In the United States, after 3 decades of decreasing TB incidence, there was a resurgence in TB cases in the mid-1980s that was strongly correlated with the HIV/AIDS epidemic. 5 , 6 Increased federal investment in TB-control programs, improvements in HIV management and prevention, and the introduction of effective antiretroviral treatment were significant factors in the reversal of the epidemic. Since 1993, the incidence of TB and TB–HIV coinfection has continued to decline throughout most of the United States. 7 , 8 In San Diego, California, where over 70% of TB cases are concentrated among individuals born outside of the United States, 9 the proportion of TB cases with HIV coinfection has remained largely unchanged in the last decade, despite a decrease in TB incidence. 10 To understand what might be driving TB–HIV dynamics in this region, we examined trends in TB cases with HIV coinfection from 1993 through 2007, as well as sociodemographic risk factors and clinical correlates of TB and HIV coinfection.
