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Background Few data exist on tuberculosis (TB) incidence according to time from HIV seroconversion in high-income countries and whether rates following initiation of a combination of antiretroviral treatments (cARTs) differ from those soon after seroconversion. Methods Data on individuals with well estimated dates of HIV seroconversion were used to analyse post-seroconversion TB rates, ending at the earliest of 1 January 1997, death or last clinic visit. TB rates were also estimated following cART initiation, ending at the earliest of death or last clinic visit. Poisson models were used to examine the effect of current and past level of immunosuppression on TB risk after cART initiation. Results Of 19 815 individuals at risk during 1982–1996, TB incidence increased from 5.89/1000 person-years (PY) (95% CI 3.77 to 8.76) in the first year after seroconversion to 10.56 (4.83 to 20.04, p=0.01) at 10 years. Among 11 178 TB-free individuals initiating cART, the TB rate in the first year after cART initiation was 4.23/1000 PY (3.07 to 5.71) and dropped thereafter, remaining constant from year 2 onwards averaging at 1.64/1000 PY (1.29 to 2.05). Current CD4 count was inversely associated with TB rates, while nadir CD4 count was not associated with TB rates after adjustment for current CD4 count, HIV-RNA at cART initiation. Conclusions TB risk increases with duration of HIV infection in the absence of cART. Following cART initiation, TB incidence rates were lower than levels immediately following seroconversion. Implementation of current recommendations to prevent TB in early HIV infection could be beneficial.

Objective To estimate the prevalence of undiagnosed HIV infection in men and women aged 16–80 years, having blood tests within primary care in Madrid, Spain. Methods A serosurvey to monitor vaccine-preventable diseases in the general population aged 16–80 years was conducted in 2008–2009. Eligible individuals were those having blood tests. The blood extraction centres, the primary sampling units, were chosen in proportion to the size and socio-economic characteristics of the target population, aiming for a sample size of 5355 subjects with equal sex distribution within five age bands. Migrants aged 16–40 years were oversampled. Previous HIV diagnoses were excluded. Prevalence rates of HIV infection with 95% CIs were estimated allocating weights inverse to their probability of selection. Results Overall, 3695 subjects agreed to participate, yielding a response rate of 69%, similar for men (66%) and women (73%); individuals recruited at healthcare centres or by telephone; and for all age groups except those aged ≥60 (57%) years. HIV infection was diagnosed in 12 subjects (0.35%; 95% CI 0.13 to 0.57); prevalence, higher in men (0.51%; 95% CI 0.12 to 0.89) than in women (0.20%; 95% CI 0.00 to 0.44); participants from other countries (0.61%; 95% CI 0.03 to 1.18) as compared with Spanish born (0.30%; 95% CI 0.06 to 0.53) and aged 21–30 years (0.65%; 95% CI 0.01 to 1.29), or 31–40 years (0.71%; 95% CI 0.02 to 1.41). None of the differences were statistically significant. Most of the 12 subjects were under follow-up for medical conditions; 11 had visited the primary care clinic in the preceding month. Conclusion The prevalence of undiagnosed HIV infection is very high and calls for strategies to unveil occult HIV infection.

Three per cent of the world's population—214 million people approximately—can be defined as international migrants and nearly half of them are women.1 The most common reason people have for migration is seeking economic improvement. Therefore, economic migrants are, on the whole, young and fit when they arrive in a new country and at an age when sexual activity and partner change is frequent. Emotional isolation is common and they build new friendships and relationships. On this basis, one would anticipate that the sexual health of economic migrants would have been highlighted as one of their major health issues but, unfortunately, it has not. This issue of Sexually Transmitted Infections contains three papers2–4 on the sexual health of Central and Eastern European (CEE) migrants in London within the SALLEE project (Sexual Attitudes and Lifestyles of London's Eastern Europeans).5 These papers show new data on the sexual and HIV risk behaviour of CEE migrants,2 their patterns of genitourinary clinic attendance and frequency of sexually transmitted infection (STI) diagnosis3 and explore the sexual risk of CEE migrant men who have sex with men (MSM).4 These papers highlight some of the methodological challenges faced in trying to minimise information and selection bias when studying migrants' health.6 One …