Em. Rubinstien et al., ACTIVE TUBERCULOSIS IN HIV-INFECTED INJECTING DRUG-USERS FROM A LOW-RATE TUBERCULOSIS AREA, Journal of acquired immune deficiency syndromes and human retrovirology, 11(5), 1996, pp. 448-454
This article describes the features of active tuberculosis in HIV-infe
cted injecting drug users (IDUs) from a low-rate tuberculosis area. Th
e cohort was followed in a hospital-based HIV/AIDS registry, and data
were extracted from the registry, patient charts, and the Tuberculosis
Control Program of the Connecticut Health Department. The setting was
an acute care inner-city hospital-based health care system, with a hi
gh incidence of AIDS, serving a small-to-medium urban area in Connecti
cut. The patients were 905 HIV-infected IDUs whose time of HIV diagnos
is (TOHD) was between 1984 and 1992. The outcome measures were demogra
phics, clinical characteristics, and morbidity rates of active tubercu
losis. Of the 27 IDUs who developed active tuberculosis, none were whi
te, ail but one were male, and only one was known to have had a positi
ve purified protein derivative (PPD) reaction prior to TOHD: 59% of ca
ses developed in patients known to be HIV infected, 11% occurred in es
tablished AIDS patients, and 67% qualified as extrapulmonary tuberculo
sis (that is, AIDS defining by pre-1993 definitions). In 22% of cases,
both Mycobacterium tuberculosis and M. avium-intracellulare were isol
ated. Mycobacterium tuberculosis was most commonly isolated from a res
piratory specimen (67%). The annual incidence rate has been less than
or equal to 1.0% since 1988. The cumulative incidence rate was highest
for patients with a positive PPD reaction or a history of tuberculosi
s (1.4 cases/100 patient years; 52 patients; mean follow-up 4.0 years)
. The demographics and clinical characteristics of active tuberculosis
in our HIV-infected IDUs are similar to those described elsewhere in
the United States; the morbidity rates are low and stable. The implica
tions of our findings on tuberculosis control in HIV-infected IDUs may
be applicable to health care systems with low tuberculosis rates.