Increasing incidence of HIV‐ associated tuberculosis in Romanian injecting drug users

Background A high prevalence of tuberculosis ( TB ) among HIV ‐positive injecting drug users ( IDU s) may fuel the TB epidemic in the general population of Romania. We determined the frequency and characteristics of TB in HIV ‐infected IDU s referred to a national centre. Methods Prospective observational cohort study of all newly‐diagnosed HIV ‐positive IDU s admitted to Victor Babes Hospital, Bucharest, between January 2009 and December 2014. Socio‐demographics, clinical characteristics and outcomes of HIV / TB co‐infected IDU s were compared to HIV ‐positive IDU s without TB . Results 170/598 (28.5%) HIV ‐infected IDU s were diagnosed with TB . The prevalence increased from 12.5% in 2009 to 32.1% in 2014 ( P < 0.001). HIV / TB co‐infected individuals had lower median CD 4 cell counts 75 ( vs . 450/mm 3 , P < 0.0001) and higher median HIV viral loads 5.6 log 10 ( vs . 4.9 log 10 , P < 0.0001) when presenting to healthcare services. 103/170 (60.6%) HIV / TB co‐infected IDU s were diagnosed with pulmonary TB . Resistant Mycobacterium tuberculosis strains were common, with 18/105 (17.1%) of patients having Multi‐Drug Resistant ( MDR ) disease. Higher mortality rate was associated with TB co‐infection ( P < 0.0001), extra‐pulmonary TB ( P = 0.0026) and extensively drug resistant TB ( P = 0.024). Conclusions Tuberculosis ( TB ) is an increasing problem in HIV ‐infected IDU s in Romania. Presentation is often with advanced HIV , significant TB drug resistance and consequent outcomes are poor.