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1 April 2006

Volume 42, Number 7
Clinical Infectious Diseases 2006;42:1040–1047
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4207-0025$15.00
DOI: 10.1086/501018
HIV/AIDS MAJOR ARTICLE

Impact of HIV Infection on the Epidemiology of Tuberculosis in a Peri‐Urban Community in South Africa: The Need for Age‐Specific Interventions

Stephen D. Lawn,1,3

Linda‐Gail Bekker,1

Keren Middelkoop,1

Landon Myer,1,2 and

Robin Wood1

1Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, and 2Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; and 3Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

Background.In August 2005, the World Health Organization declared the tuberculosis (TB) epidemic in Africa to be a regional emergency. Current TB‐control measures are failing, largely as a result of the human immunodeficiency virus (HIV) epidemic. Evaluation of additional control interventions requires detailed understanding of the epidemiological relationship between these diseases at the community level.

Methods.We examined age‐ and sex‐specific trends in TB notifications and their association with the prevalence of HIV infection in a peri‐urban township in South Africa during 1996–2004. Denominators for TB notifications were derived from population census data. The local TB‐control program used the World Health Organization directly observed treatment, short‐course (DOTS) strategy.

Results.TB notification rates increased 2.5‐fold during the period, reaching a rate of 1468 cases per 100,000 persons in 2004 ( , by test for trend); the estimated population prevalence of HIV infection increased from 6% to 22% during the same period. After stabilization of prevalence of HIV infection, the TB notification rate continued to increase steeply, indicating ongoing amplification of the TB epidemic. In 2004, at least 50% of children aged 0–9 years who developed TB were HIV infected. Annual TB notification rates among adolescents increased from 0 cases in 1996–1997 to 436 cases per 100,000 persons in 2003–2004, and these increases were predominantly among female. However, 20–39‐year‐old persons were affected most, with TB notification rates increasing from 706 to 2600 cases per 100,000 persons among subjects in their 30s. In contrast, TB rates among persons aged >50 years did not change.

Conclusions.HIV infection is driving the TB epidemic in this population, and use of the DOTS strategy alone is insufficient. TB notifications have reached unprecedented levels, and additional targeted, age‐specific interventions for control of TB and HIV infection in such populations are needed.

Received 23 September 2005; accepted 8 November 2005; electronically published 16 February 2006.

  • (See the editorial commentary by Whalen on pages 1048–50)

Reprints or correspondence: Dr. Stephen D. Lawn, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Rd., Observatory 7925, Cape Town, South Africa ().

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