Modeling the impact of HIV on the spread of tuberculosis in the United States

Tuberculosis (TB) was thought to be safely in decline in the United States in the mid-1980s because the number of cases had dropped by 74% between 1953 and 1985. An increase in TB cases was reported, however, in 1986, and an upward trend in TB incidence has continued. The turnaround in TB is well correlated with the rise of the HIV (human immunodeficiency virus) epidemic. The purpose of this work is to investigate, through the use of mathematical models, the magnitude and duration of the effect that the HIV epidemic may have on TB. Models are developed which reflect the transmission dynamics of both TB and HIV, and the relative merits of these models are discussed. The models are then linked together to form a model for the combined spread of both diseases. A numerical study is performed to investigate the influence of certain key parameters. The effect that HIV will have on the general population is found to be dependent on the contact structure between the general population and the HIV risk groups, as well as a possible shift in the dynamics associated with TB transmission. (C) Elsevier Science Inc., 1997.