title: A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection.
abstract: To determine the risk of active tuberculosis associated with human immunodeficiency virus (HIV) infection, we prospectively studied 520 intravenous drug users enrolled in a methadone-maintenance program. Tuberculin skin testing and testing for HIV antibody were performed in all subjects. Forty-nine of 217 HIV-seropositive subjects (23 percent) and 62 of 303 HIV-seronegative subjects (20 percent) had a positive response to skin testing with purified protein derivative (PPD) tuberculin before entry into the study. The rates of conversion from a negative to a positive PPD test were similar for seropositive subjects (15 of 131; 11 percent) and seronegative subjects (26 of 202; 13 percent) who were retested during the follow-up period (mean, 22 months). Active tuberculosis developed in eight of the HIV-seropositive subjects (4 percent) and none of the seronegative subjects during the study period (P less than 0.002). Seven of the eight cases of tuberculosis occurred in HIV-seropositive subjects with a prior positive PPD test (7.9 cases per 100 person-years, as compared with 0.3 case per 100 person-years among seropositive subjects without a prior positive PPD test; rate ratio, 24.0; P less than 0.0001). We conclude that, although the prevalence and incidence of tuberculous infection were similar for both HIV-seropositive and HIV-seronegative intravenous drug users, the risk of active tuberculosis was elevated only for seropositive subjects. These data also suggest that in HIV-infected persons tuberculosis most often results from the reactivation of latent tuberculous infection; our results lend support to recommendations for the aggressive use of chemoprophylaxis against tuberculosis in patients with HIV infection and a positive PPD test.
authors.affiliation: Department of Epidemiology and Social Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, New York 10467.
authors.forename: P A
authors.initials: PA
authors.lastname: Selwyn
authors.forename: D
authors.initials: D
authors.lastname: Hartel
authors.forename: V A
authors.initials: VA
authors.lastname: Lewis
authors.forename: E E
authors.initials: EE
authors.lastname: Schoenbaum
authors.forename: S H
authors.initials: SH
authors.lastname: Vermund
authors.forename: R S
authors.initials: RS
authors.lastname: Klein
authors.forename: A T
authors.initials: AT
authors.lastname: Walker
authors.forename: G H
authors.initials: GH
authors.lastname: Friedland
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D005260:Female; D015483:HIV Antibodies / Q000032:analysis; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009519:New York City; D011446:Prospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications*; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology / Q000209:etiology*
chemical_list: D015483:HIV Antibodies