TESTING FOR HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN PATIENTS WITH TUBERCULOSIS

To investigate the utility of testing all tuberculosis patients for HI V infection in Los Angeles, we prospectively evaluated 183 hospitalize d patients with acid-fast smear-positive tuberculosis who gave no hist ory of HIV infection. HIV serologic testing was performed, and the pre sence of risk factors for HIV infection was assessed by interview and review of the medical record. Thirty-three patients (18%) were infecte d with HIV. Based on data obtained by interview, 124 (68%) of 183 pati ents had at least one risk factor for HIV infection. The most common r isk factors were related to heterosexual transmission of HIV (prostitu te contact, multiple sex partners, and a history of sexually transmitt ed disease). These risk factors were frequently not documented in the medical record. Among the 33 patients who were infected with HIV, 30 w ere identified by interviewing as having significant risk factors. We concluded that most tuberculosis patients in Los Angeles have risk fac tors for HIV infection and that systematic questioning does not identi fy risk factors in all HlV-infected tuberculosis patients. These data support current recommendations to screen all tuberculosis patients fo r HIV infection.