P30. Epidemiology and outcome of HIV-patients co-infected with tuberculosis in Finland

Ville Holmberg, Hanna Soini, Pia Kivelä, Matti Ristola
Affiliates: VH, PK and MR: Clinic of Infectious Diseases, Helsinki University Hospital, Finland HS: National Institute of Health and Welfare, Department of Infectious Diseases, Finland

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Background
Tuberculosis (TB) is a major cause of death in HIV patients in Africa and Asia. However, data about the outcome of HIV-TB co-infections in high-income countries with low TB incidence have been limited. Helsinki is reached easily by boat from Estonia or by train from Russia, both of which are countries with high prevalence of TB.

Methods
The HIV-cohort at the Helsinki University Hospital including 1849 patients between 1998 and 2015 was analyzed for this study. Data for the study was collected from the InfCare HIV database and from the electronic patient records of the hospital. All new HIV and TB diagnoses were confirmed from the National Infectious Disease Register and the causes of death were obtained from Statistics Finland.

Results
Between 1998 and 2015 TB was diagnosed in 61 HIV-patients in the cohort. TB was seen in 4.3% of the females and in 2,8% of the males. TB was more frequent in intravenous drug users and in heterosexuals than in men having sex with men (4,3%, 4,2% and 1,4 %, p = 0.01). Among the 61 TB cases, treatment was completed in 43 (70.5%). Three died during treatment, three has the treatment discontinued, five were transferred out, none had treatment failure and for 7 data was not available. Thirty patients were native Finns. Ten patients originated from Asia, 15 from Sub-Saharan Africa and four from the area of former Soviet Union. Totally 16 (26.2%) TB co-infected patients died during an average follow-up time of 9.6 years. Fifteen males (39.5%) and one female (4.3%) died. Intravenous drug users and men having sex with men had higher risk for death compared to those with heterosexual transmission of HIV (53.8%, 40.0%, 15.2%). Among co-infected born in Western countries 15 died (46.9%), whereas only one (7.7%) born in Africa and none of those born in Asia, Latin America or Eastern Europe died. None of the deaths were directly related to the previous TB infection. Five patients had HIV as primary cause of death.

Conclusions
The number of new HIV-TB co-infections in Finland remains at a low and stable level. Despite good treatment results for both HIV and TB, the all-cause mortality among Finnish males is as high as 54% during follow up. The reason for this very high mortality rate is most likely an accumulation of other risk factors of early death, such as heavy alcohol consumption, smoking, intravenous drug use and psychiatric illness. On the other hand, among HIV-positive females and migrants, TB-infection do not seem to affect their long-term prognosis.