TESTING FOR HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION AMONG TUBERCULOSISPATIENTS IN LOS-ANGELES

To investigate patterns of testing for human immunodeficiency virus (H IV) infection in tuberculosis patients, we obtained data from the tube rculosis registry and from medical records of 500 tuberculosis patient s in Los Angeles County. Sixty-three percent of tuberculosis patients were tested for HIV infection, and multivariate logistic regression an alysis revealed that the likelihood of testing was significantly highe r among males, persons between 20 and 49 yr old, individuals with HIV risk factors, and patients treated by public health care providers. A minim um of 12% of the total sample, 2% of females, 2% of those outsid e the ages of 20 to 49, 7% of patients without recorded HIV risk facto rs, and 17% of patients treated by private practitioners were infected with HIV. These results suggest that health care providers, particula rly private practitioners, do not follow national recommendations for universal HIV testing of tuberculosis patients. Instead, HIV testing i s preferentially performed on patients perceived to be at high risk fo r HIV infection. Because HIV seroprevalence is at least 2 to 7% in ''l ow-risk'' groups, failure to test these patients may result in signifi cant missed opportunities for diagnosis and treatment of HIV coinfecti on.