HIV-1 SEROPREVALENCE IN CHEST CLINIC AND HOSPITAL TUBERCULOSIS PATIENTS IN NEW-YORK-CITY, 1989-1991

Objective: To describe more fully HIV-1 and tuberculosis (TB) coinfect ion in TB patients attending New York City Department of Health chest clinics (1989-1991) and one inner-city hospital (1990-1991). Design: A n unlinked serosurvey using HIV-1-antibody testing of remnant blood sp ecimens collected for routine medical purposes. Subjects: A total of 1 414 clinic and 856 hospital patients. Outcome measures: HIV seropositi vity and TB infection/disease. Results: A total of 327 (23%) of the cl inic patients were HIV-1-positive, with a significantly higher seropre valence in men (29 versus 15%, P<0.001) and in young and middle-aged a dults aged 30-50 years (P<0.001). HIV-1 prevalence by TB diagnostic cl ass was: class 2 (purified protein derivative-positive and chest radio graph-negative), 11% (64 out of 570); class 3 (active disease), 34% (1 97 out of 582); class IV (old/inactive disease), 30% (39 out of 130). Of the hospital patients 487 (57%) were HIV-1-positive. HIV-1 seroprev alence was 55% for those who were identified or believed to be HIV-1-n egative on admission as indicated on the medical chart. HIV-1 seroprev alence in the clinic population decreased initially, but later increas ed, although not to study onset levels. Conclusions: There is consider able overlap between the TB and HIV epidemics in New York City; a part of the increasing TB incidence may be independent of HIV coinfection. The control of TB will necessitate prompt diagnosis of TB and HIV-1, appropriate TB treatment and/or chemoprophylaxis, and a greater commit ment to tackle the social conditions associated with the spread of the disease.