TUBERCULOSIS AND HIV-INFECTION AMONG FEMALE INMATES IN SAO-PAULO, BRAZIL - A PROSPECTIVE COHORT STUDY

Prison populations are at increased risk of both human immunodeficienc y virus (HIV) and Mycobacterium tuberculosis infections, but among fem ale inmates information on such risks remains scarce, especially in de veloping countries. Between October 1992 and November 1993, 350 women incarcerated at a prison in Sao Paulo, Brazil, were prospectively eval uated for HIV and M. tuberculosis infection and disease. Among them, 8 7 (25%) were HIV seropositive, and 20 (5.7%) had tuberculosis (TB). Du ring the incarceration period, the purified protein derivative test co nversion rate was 29% for HIV-positive and 32% for HIV-negative women. However, the incidence of TB was 9.9 per 100 person-years for HIV-pos itive and 0.7 per 100 person-years of incarceration for HIV-negative w omen (p < 0.0001). A multivariate analysis indicated that HIV infectio n (p < 0.0001) and incarceration time <12 months (p < 0.05) were each associated with TB. These findings indicate that new transmissions of M. tuberculosis infection are common among female inmates and that HIV -infected women are more likely to acquire active disease during the f irst 12 months of incarceration. Because of their role in childbearing and care, female inmates are an important potential source of transmi ssion of M. tuberculosis, and new strategies to control the spread of TB in prisons need to be developed.