TUBERCULOSIS INFECTION IN HUMAN IMMUNODEFICIENCY VIRUS-POSITIVE ADOLESCENTS AND YOUNG-ADULTS - A NEW-YORK-CITY COHORT

Objectives. Adolescents with human immunodeficiency virus (HIV) infect ion are at increased risk for tuberculosis (TB), underscoring the impo rtance of early identification of TB infection. The goals of this stud y were to assess the factors associated with the completion of evaluat ions for TB in a cohort of HIV-positive adolescents and young adults a nd to describe the prevalence of Myobacterium tuberculosis infection a nd adherence to antituberculous treatment regimens. Methods. A retrosp ective chart review was done for all HIV-positive adolescents and youn g adults, ages 13 to 21 years (n = 49), seen in a comprehensive care p rogram from January 1991 through December 1992. Data collected include d CD4 cell count, HIV clinical status, living situation, substance use history, and the completion of an annual evaluation for TB infection. The evaluation consisted of a tuberculin skin test (Mantoux test), us ing an intraepidermal injection of 0.1 mt of 5 tuberculin units of pur ified protein derivative (PPD) and a simultaneous Merieux multitest an ergy panel. Chi-square analysis was used to assess the association bet ween the completion of the evaluation for TB and both living status an d substance use. Results. Thirty-one (63%) of 49 patients completed ev aluations for TB. Of the 31 completed evaluations, 18 were assessed by clinic staff on site, and 13 were assessed by other medical or traine d nonmedical observers through community networking efforts. Neither h omelessness nor illicit substance use were factors in the completion o f the evaluation. Six (19%) of the 31 patients had positive PPD skin t est results. Three had medical histories and chest radiographs suggest ing active TB, and all were hospitalized for at least 2 weeks. Two had positive cultures for M tuberculosis, although the third also respond ed clinically to antituberculous therapy. All three were otherwise asy mptomatic for HIV infection, with only moderately depressed CD4 cell c ounts. All three were homeless and used crack cocaine. After the initi al treatment as inpatients, none completed treatment within the prescr ibed time period. Conclusions. The completions of the evaluations for TB were greatly facilitated by community networking, but innovative st rategies to enhance both screening and treatment programs, such as tra ining youth service providers in the community to read PPD skin tests, expansion of directly observed therapy services, and youth-centered p rograms for housing and substance use, need further development. The h igh prevalence of TB in the cohort underscores the need for providers to increase efforts to identify cases of TB infection among adolescent s and young adults and to incorporate HIV risk assessment, counseling, and testing into their practices routinely.