title: Active and latent tuberculosis among HIV-positive injecting drug users in Indonesia.
abstract: BACKGROUND
  Injecting drug use (IDU) is associated with tuberculosis but few data are available from low-income settings. We examined IDU in relation to active and latent tuberculosis (LTBI) among HIV-positive individuals in Indonesia, which has a high burden of tuberculosis and a rapidly growing HIV epidemic strongly driven by IDU.
  
  
  METHODS
  Active tuberculosis was measured prospectively among 1900 consecutive antiretroviral treatment (ART)-naïve adult patients entering care in a clinic in West Java. Prevalence of LTBI was determined cross-sectionally in a subset of 518 ART-experienced patients using an interferon-gamma release assay.
  
  
  RESULTS
  Patients with a history of IDU (53.1%) more often reported a history of tuberculosis treatment (34.8% vs. 21.9%, p < 0.001), more often received tuberculosis treatment during follow-up (adjusted HR = 1.71; 95% CI: 1.25-2.35) and more often had bacteriologically confirmed tuberculosis (OR = 1.67; 95% CI: 0.94-2.96). LTBI was equally prevalent among people with and without a history of IDU (29.1 vs. 30.4%, NS). The risk estimates did not change after adjustment for CD4 cell count or ART.
  
  
  CONCLUSIONS
  HIV-positive individuals with a history of IDU in Indonesia have more active tuberculosis, with similar rates of LTBI. Within the HIV clinic, LTBI screening and isoniazid preventive therapy may be prioritized to patients with a history of IDU.
authors.affiliation: Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Hinta
authors.initials: H
authors.lastname: Meijerink
authors.affiliation: Health Research Unit, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia.|Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia.
authors.forename: Rudi
authors.initials: R
authors.lastname: Wisaksana
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia.
authors.forename: Mery
authors.initials: M
authors.lastname: Lestari
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia.
authors.forename: Intan
authors.initials: I
authors.lastname: Meilana
authors.affiliation: Health Research Unit, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia.
authors.forename: Lydia
authors.initials: L
authors.lastname: Chaidir
authors.affiliation: Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Andre J A M
authors.initials: AJ
authors.lastname: van der Ven
authors.affiliation: Health Research Unit, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia.
authors.forename: Bachti
authors.initials: B
authors.lastname: Alisjahbana
authors.affiliation: Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Reinout.vanCrevel@radboudumc.nl.
authors.forename: Reinout
authors.initials: R
authors.lastname: van Crevel
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D055985:Latent Tuberculosis / Q000453:epidemiology; D008297:Male; D015819:Substance Abuse, Intravenous / Q000150:complications*; D014376:Tuberculosis / Q000453:epidemiology*
keywords: Mycobacterium tuberculosis; cohort studies; human immunodeficiency virus; intravenous; latent tuberculosis infection; substance abuse