Tuberculosis and HIV co-infection in healthcare workers in England and Wales, 1999-2005

This study used linked national tuberculosis (TB) and HIV surveillance data to investigate recent trends and factors associated with HIV co-infection (TB-HIV) in healthcare workers (HCWs) with TB in England and Wales. Methods applied were the chi(2) trend test and logistic regression. Overall 14% (231/1627) of HCWs with TB were co-infected with HIV, increasing from 8% in 1999 to 14% in 2005 (P<0.001). Most (78%) HCWs were non-UK born and 74% of these developed TB >= 2 years post-entry. Being born in Sub-Saharan Africa was an independent predictor for TB-HIV, especially for female HCWs (odds ratio 66.5, 95% confidence interval 16.3-271.1), who also had a lower median CD4 count than other co-infected women (106/mm(2), interquartile range 40-200, P<0.01). Voluntary HIV testing of new HCWs should be encouraged as an opportunity for early diagnosis. Post-entry, a high index of clinical suspicion for TB in those most at risk remains important.