Changes in the epidemiology and clinical manifestations of human immunodeficiency virus-associated tuberculosis in Hong Kong.

Introduction: Human immunodeficiency virus (HIV)-associated tuberculosis (TB) remains an important health challenge worldwide. Although TB prevalence has decreased in the general population, there is limited information regarding temporal trends in the incidence of HIV-associated TB in Hong Kong. There are also insufficient data regarding changes in clinical manifestation patterns among HIV-associated TB patients over time. This study aimed to describe temporal trends in the epidemiology and clinical manifestations of HIV-associated TB in Hong Kong.

Methods: We retrospectively reviewed data regarding HIV-associated TB patients that were reported to the TB-HIV Registry of the Department of Health during the period 2007 to 2020. Trends of TB as a primary acquired immunodeficiency syndrome (AIDS)-defining illness, as well as changes in demographic features and clinical manifestations of HIV-associated TB during this period were examined using Cochran-Armitage trend test.

Results: A decreasing trend was observed in the proportion of all reported cases of AIDS in which TB was a primary AIDS-defining illness during the study period. The proportions of female patients and patients with extrapulmonary involvement significantly increased, whereas the proportions of ever-smokers and patients with sputum smear positivity significantly decreased during the same period. A decreasing trend was observed in the proportion of patients with pulmonary TB in which the lower zone was the predominant site of lung parenchymal lesions. Among patients with a diagnosis of HIV infection before TB, an increasing trend was observed in the proportion of patients receiving antiretroviral therapy.

Conclusion: Important temporal changes were observed in the epidemiology and clinical manifestations of HIV-associated TB. These results highlight the need for continued surveillance regarding the patterns of demographic features and clinical manifestations to inform policymakers when planning control strategies for HIV-associated TB.