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PLoS One. 2016 Nov 3;11(11):e0165944. doi: 10.1371/journal.pone.0165944. eCollection 2016.

Environmental Factors Related to Pulmonary Tuberculosis in HIV-Infected Patients in the Combined Antiretroviral Therapy (cART) Era.

Author information

Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain.
Unit of HIV Surveillance and Behavioural Monitoring. National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain.
Network of Biomedical Research Centers Epidemiology and Public Health (Centro de Investigacion Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)), Madrid, Spain.
Pneumology Service, Hospital General Universitario Gregorio Marañón. Universidad Complutense de Madrid, Madrid, Spain.
Department of Human Geography, Faculty of Geography and History, Complutense University of Madrid. Madrid, Spain.
Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda. Madrid, Spain.


The aim of our study was to evaluate the seasonal variations and whether short-term exposure to environmental risk factors, such as climate and air pollution, is associated with PTB-related hospital admissions in human immunodeficiency virus (HIV)-infected patients in Spain during the era of combined antiretroviral therapy (cART). A retrospective study was carried out using data from the Minimum Basic Data Set (MBDS) and the State Meteorological Agency (AEMET) of Spain. The primary outcome variable was hospital admissions with PTB diagnosis. The environmental risk factors evaluated were season, temperature, humidity, NO2, SO2, O3, PM10, and CO. Overall, HIV-infected patients had a lower frequency of PTB-related hospital admissions in summer (22.8%) and autumn (22.4%), but higher values in winter (26.6%) and spring (28.2%). Using a Bayesian temporal model, PTB-related hospital admissions were less frequent in summer-autumn and more abundant in winter-spring during the first years of follow-up. During the later years of follow-up, the seasonal trends continued resulting in the lowest values in autumn and the highest in spring. When considering short-term exposure to environmental risk factors, lower temperatures at 1 week (odds ratio (OR) = 1.03; p = 0.008), 1.5 weeks (OR = 1.03; p<0.001), 2 weeks (OR = 1.04; p<0.001), and 3 weeks (OR = 1.03; p<0.001) prior to PTB admission. In addition, higher concentration of NO2 at the time of admission were significantly associated with higher likelihoods of PTB-related hospital admission in HIV-infected patients when 1.5 weeks (OR = 1.1; p = 0.044) and 2 weeks (OR = 1.21; p<0.001) were used as controls. Finally, higher concentration of SO2 at 1.5 weeks prior to PTB admission was significantly associated with a higher likelihood of PTB-related hospital admissions (OR = 0.92; p = 0.029). In conclusion, our data suggest an apparent seasonal variation in hospital admissions of HIV-infected patients with a PTB diagnosis (summer/autumn vs. winter/spring), as well as a link to short-term exposure to environmental risk factors, such as temperature and ambient NO2 and SO2.

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