The HIV epidemic and its effect on the tuberculosis situation in The Netherlands.

To determine the influence of the HIV (human immunodeficiency virus) epidemic on the tuberculosis situation in the Netherlands, we made a retrospective analysis of all reported tuberculosis cases from 1984 through 1990. We studied the course of the tuberculosis incidence in the Netherlands among the group at highest risk for HIV infection (Dutch males, 25–49 years of age, in Amsterdam). This was compared with the course among same-age Dutch males in areas with lower risk for HIV infection and among other-age Dutch males in Amsterdam. The tuberculosis incidence among Dutch males aged 25–49 years in Amsterdam increased from 16.1 in 1984 to 34.7 per 100 000 in 1990 (χ2 for trend, P < 0.01). The incidences among Dutch males in other places of residence in this age group and among other-age Dutch males in Amsterdam remained stable or decreased during the same period. As this increase could not be ascribed to tuberculosis among other risk groups, it appears to be related to the HIV epidemic among male homosexuals. Our results indicate that, even in a country where the prevalence of tuberculous infection is low, an increase of tuberculosis among certain subgroups can be observed as the result of the HIV epidemic.