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.

Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults.

“…B. Curtis et al, 2000;Daley, Hahn, Moss, Hopewell, & Schecter, 1998;Munch et al, 2003;Nardell, McInnis, Thomas, & Weidhaas, 1986;Selwyn et al, 1989;Small & Fujiwara, 2001). TB risk is higher among injection drug users (IDUs) compared with the general population as IDU behaviors increase risk of HIV and bring people into proximity with others who may have active TB (R. Curtis et al, 1994).…”

Tuberculosis control in the era of HIV

“…In those infected with HIV, however, CD4 + T-cell counts steadily decline as the infection progresses and the ability to restrict the tuberculous bacilli to a few infected macrophages is lost. The risk of developing TB disease in those that are co-infected with HIV by reactivating a latent tuberculous infection increases to 5-15% annually 17,18 , rising as immune deficiency worsens 19 . Rapid progression from infection to TB disease can also occur in markedly immunosuppressed patients.…”

The changing face of tuberculosis: Trends in tuberculosis-associated skeletal changes

“…18 HIV is also frequently the cause of progression of dormant disease into full-blown TB and causes rapid progression of the disease. 19 HIV-related TB is most common in Sub-Saharan countries, making up 79% of such cases known worldwide. 20 TB is now the most common cause of HIV-related deaths, and occurs in at least a third of HIV positive people in sub-Saharan Africa.…”