IMPACT OF THE HIV EPIDEMIC ON TRENDS IN TUBERCULOSIS IN ABIDJAN, COTE-DIVOIRE

Setting: West African capital city with excellent, population-based notification of tuberculosis cases during a decade with a rapidly emerging HIV epidemic. Objective: To evaluate the impact of the HIV epidemic on tuberculosis in Abidjan, Cote d'Ivoire. Design: Review of data on all cases of tuberculosis registered in the city in alternate years from 1981 to 1991 and calculation of population-based rates using census data. Also, systematic study of HIV seroprevalence among tuberculosis patients in 1989 and 1991. Results: In 1981, several years before any health consequences of HIV were discernible in Abidjan, the incidence of tuberculosis was 155 per 100 000. By 1991, the rate of tuberculosis among HIV-seronegative persons had decreased by 38% to 96 per 100 000; however, 43.6% of tuberculosis patients were HIV-infected, and the incidence of tuberculosis among HIV-infected persons was 1104 per 100 000 (relative risk 11.5, 95% CI 10.8-12.3), yielding an overall observed incidence of tuberculosis of 159 per 100 000 population. The population attributable risk of tuberculosis due to HIV infection increased from 36% to 40% between 1989 and 1991. Conclusions: The HIV epidemic has reversed the expected steep decline in tuberculosis in Abidjan over the past decade, and the impact of HIV infection on the incidence of tuberculosis may be accelerating.