title: Tuberculin sensitivity and HIV-1 status of patients attending a sexually transmitted diseases clinic in Lusaka, Zambia: a cross-sectional study.
abstract: A cross-sectional study to estimate the prevalence of latent tuberculosis (TB) in a group of Zambians at high risk of human immunodeficiency virus type 1 (HIV-1) infection and to examine the effect of HIV-1 infection on the tuberculin response was conducted in the University Teaching Hospital in Lusaka, Zambia during July to September 1990. Patients were selected from those presenting to the out-patient clinic for first referral with either sexually transmitted or skin disease. 268 adults were included in the study; 158 (59%; 95% confidence interval [CI] = 53-65%) were HIV-1 antibody positive. Of 82 HIV-1 negative participants who returned for Mantoux skin test reading, 51 (62%; 95% CI = 57-67%) had a positive test reaction (diameter > or = 10 mm) after receiving 2 units of RT-23 tuberculin. Of 106 HIV-1 positive participants who returned, only 32 (30%; 95% CI = 26-34%) had a diameter > or = 10 mm. Nine (28%) of the HIV-1 positive and Mantoux positive participants had large reactions > or = 30 mm, compared to 4 (8%) of the HIV-1 negative, Mantoux positive participants (P = 0.03). Results in the HIV-1 negative group indicated a prevalence of latent TB of 62% in this population. HIV-1 infection was associated with a much higher frequency of negative response to tuberculin and with a few large skin test responses. Thus, in populations where HIV seropositivity is high, Mantoux skin tests cannot be used to assess those with latent TB who might benefit from chemoprophylaxis.
authors.affiliation: School of Medicine, University of Zambia, Lusaka.
authors.forename: L E
authors.initials: LE
authors.lastname: Duncan
authors.forename: A M
authors.initials: AM
authors.lastname: Elliott
authors.forename: R J
authors.initials: RJ
authors.lastname: Hayes
authors.forename: S K
authors.initials: SK
authors.lastname: Hira
authors.forename: G
authors.initials: G
authors.lastname: Tembo
authors.forename: G T
authors.initials: GT
authors.lastname: Mumba
authors.forename: S H
authors.initials: SH
authors.lastname: Ebrahim
authors.forename: M
authors.initials: M
authors.lastname: Quigley
authors.forename: J O
authors.initials: JO
authors.lastname: Pobee
authors.forename: K P
authors.initials: KP
authors.lastname: McAdam
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D015497:HIV-1; D006801:Humans; D008297:Male; D015995:Prevalence; D011897:Random Allocation; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D015024:Zambia / Q000453:epidemiology