Long-Term Effectiveness of Diagnosing and Treating Latent Tuberculosis Infection in a Cohort of HIV-Infected and At-Risk Injection Drug Users
- 1 December 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in JAIDS Journal of Acquired Immune Deficiency Syndromes
- Vol. 49 (5), 532-537
- https://doi.org/10.1097/qai.0b013e31818d5c1c
Abstract
Introduction: Between 1990 and 1998, tuberculin skin tests (TST) and isoniazid preventive therapy (IPT) were provided to injection drug users participating in the AIDS Linked to the Intravenous Experiences cohort. Methods: A registry match was conducted with the AIDS Linked to the Intravenous Experiences cohort database and the Maryland State Department of Health and Mental Hygiene tuberculosis registry. Results: Of 2010 participants, 1753 (74%) had a TST placed and read; 536 (31%) were positive. TST positivity was 16% in HIV positives; 39% in HIV negatives (P < 0.01). Overall, 299 (56%) TST reactors started IPT; 165 (55%) completed 6 months. Three tuberculosis (TB) cases were diagnosed among HIV negatives (incidence rate = 0.16/1000 person-years); 19 among HIV positives (1.94/1000 person-years; incidence rate ratio = 12.3 (3.61-64.70). Within the entire cohort, TB rates were 0.81 per 1000 person-years for those not receiving IPT, 0.48 per 1000 person-years for those receiving any IPT, 0.29 per 1000 person-years for those completing at least 30 days, and 0 per 1000 person-years for completers. Ten cases of TB occurred in HIV-infected individuals with negative TSTs. Discussion: IPT was associated with protection against TB, but uptake was modest. Although it is likely that TB incidence would have increased, especially in HIV-positive subjects, if the IPT program had not occurred, more significant declines in TB incidence in this population will require improved methods for ensuring uptake and completion of IPT and preventing disease in TST-negative individuals.Keywords
This publication has 23 references indexed in Scilit:
- The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, BrazilAIDS, 2007
- Effect of HIV-1 Infection on T-Cell–based and Skin Test Detection of Tuberculosis InfectionAmerican Journal of Respiratory and Critical Care Medicine, 2007
- Reducing Tuberculosis Incidence by Tuberculin Skin Testing, Preventive Treatment, and Antiretroviral Therapy in an Area of Low Tuberculosis TransmissionClinical Infectious Diseases, 2007
- Incidence of Tuberculosis among HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy in Europe and North AmericaClinical Infectious Diseases, 2005
- Tuberculosis among HIV-infected patients receiving HAART: long term incidence and risk factors in a South African cohortAIDS, 2005
- Treatment of latent tuberculosis infection in HIV infected personsPublished by Wiley ,2004
- Characteristics of injection drug users who utilize tuberculosis services at sites of the baltimore city needle exchange programJournal of Urban Health, 2002
- Clinical Manifestations and Predictors of Disease Progression in Drug Users with Human Immunodeficiency Virus InfectionThe New England Journal of Medicine, 1992
- An Outbreak of Tuberculosis with Accelerated Progression among Persons Infected with the Human Immunodeficiency VirusThe New England Journal of Medicine, 1992
- A Prospective Study of the Risk of Tuberculosis among Intravenous Drug Users with Human Immunodeficiency Virus InfectionThe New England Journal of Medicine, 1989