RISK OF TUBERCULOSIS IN INTRAVENOUS DRUG-ADDICTS HIV-SEROPOSITIVE - ACOHORT STUDY IN DRUG-ADDICT DETOXICATION COMMUNITIES

BACKGROUND: The aim of this study was to determine the risk of active tuberculosis in intravenous drug addict (IVDA) patients seropositive a nd seronegative for the HIV. METHODS: A retrospective study of a cohor t of IVDA males in 2 drug addict detoxication communities was carried out. Patients with tuberculosis, under treatment or chemoprophylaxis f or tuberculosis and those with a stay of less than 3 months were exclu ded. Patients included underwent a serologic study to detect antibodie s versus HIV and a Mantoux test with 2 U. PPDRT23. Subjects who were H IV+ with a Mantoux test < 5 mm were given a delayed cutaneous sensitiv ity test with 7 antigens. The incidence index of tuberculosis was stud ied. Logistic regression analysis was performed to evaluate the relati ve risk of tuberculosis in HIV+ controlled by other variables (having been in prison, previous liver disease, country of origin, age, length of IVDA and length of follow up). RESULTS: Of the 198 patients admitt ed 132 were included. Forty-seven were HIV+ and 85 HIV-. Fourteen of t he former (30 %) and 44 of the latter (51 %) had a positive reaction t o the Mantoux test (OR 0.4; confidence interval 95 % 0.18-0.92; p < 0. 05). Eight seropositive (17 %) patients with a negative Mantoux test p resented anergia to the delayed cutaneous sensitivity tests. After a m ean follow up of 12.0 +/- 9.0 months, 4 patients out of the 47 HIV+ (8 .5 % or 6.93 cases/100 individuals/year; CI 95 % 0.13-13.72) presented tuberculosis versus none of the 85 HIV- (p < 0.05) patients. Of the 4 patients diagnosed of tuberculosis, the initial reaction to the Manto ux test was negative in 2 (one pulmonary and the other milliar tubercu losis). Two of the 4 patients diagnosed of tuberculosis died. CONCLUSI ONS: The risk of active tuberculosis is specially high in HIV seroposi tive intravenous drug addicts. The response to the Mantoux test has li ttle sensitivity for demonstration of tuberculous infection in HIV ser opositive patients.