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Free Content The influence of HIV infection and imprisonment on dissemination of Mycobacterium tuberculosis in a large Spanish city

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SETTING: Culture-positive cases of tuberculosis (TB) from the urban population of southern Madrid and from all the prisons located throughout the city.

OBJECTIVE: To determine the frequency with which common strains of Mycobacterium tuberculosis cause disease among patients from both the urban and prison populations of a large Spanish city.

DESIGN: Restriction fragment length polymorphism analysis was performed on culture-positive cases of TB identified between 1 January 1997 and 31 December 1998. Risk factors that might be associated with the dissemination of common strains of TB among the two populations were also investigated.

RESULTS: Two hundred and twenty-one cases of culture-positive TB were identified, 99 (47.8%) of which were grouped in 23 clusters. Eleven were general clusters that spanned the prison and urban populations involved 69 patients (31.2%). Univariate analysis of risk factors showed that age <35 years, human immunodeficiency virus (HIV) infection, intravenous drug use and current or previous imprisonment were all associated at a statistically significant level with inclusion in general clusters. The final logistic regression model showed an interaction between HIV infection and incarceration.

CONCLUSIONS: Dissemination of common strains of M. tuberculosis between prison inmates and the urban population of Madrid is significant, and involves subjects with a history of imprisonment and HIV infection.

Keywords: HIV; Mycobacterium tuberculosis; molecular epidemiology; prison; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Subdirección General de Sanidad Penitenciaria, Dirección General de Instituciones Penitenciarias, Madrid, Spain 2: Servicio de Salud Pública del Area 11, Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain 3: Servicio Médico Centro Penitenciario Madrid-2 de Alcalá de Henares, Madrid, Spain 4: Servicio de Microbiología, Hospital Universitario Doce de Octubre, Madrid, Spain

Publication date: 2001-08-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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