HIV TESTING IN PATIENTS WITH TUBERCULOSIS - PHYSICIAN RESPONSE TO NATIONAL RECOMMENDATIONS

The epidemic of human immunodeficiency virus (HIV) disease has contrib uted to the resurgence of tuberculosis in the United States. For clini cal and public health reasons, the Advisory Council for the Eliminatio n of Tuberculosis has recommended that all patients with tuberculosis be tested for HIV antibodies. We reviewed the medical records of all p atients with tuberculosis in whom a diagnosis was made at a Detroit me dical center from July 1, 1986 to June 30, 1990, before and after reco mmendations were issued. Of 195 patients, 69 (35.4%) were tested for H IV antibodies: 73.7% of 57 patients whose medical records documented r isk behaviors for HIV infection, and 19.6% of 138 patients who denied high-risk behaviors or whose medical records contained no risk informa tion (relative risk of testing among patients with documented risk fac tors compared with others, 3.8; 95% confidence interval, 2.6 to 5.5). Testing of patients who denied risk behaviors or had no information in their records increased from 14.9% in the first 12 months to 30.4% in the last (p = 0.08, test for trend). In this population, national rec ommendations appear to have stimulated HIV testing, although most pati ents still are not being tested.