The incidence of tuberculosis in drug users with small tuberculin reaction sizes
Abstract:SETTING: In persons infected with the human immunodeficiency virus (HIV), a decreased tuberculin reaction cut-point of ≥5 mm induration is recommended.
OBJECTIVE: To determine tuberculosis risk in non-anergic HIV-infected persons with 5–9 mm tuberculin reactions.
DESIGN: A prospective study with semi-annual tuberculin and anergy testing, HIV antibody and T cell subset assays, and active surveillance for tuberculosis.
RESULTS: Participants were 572 HIV-seronegative and 241 HIV-seropositive non-anergic drug users. No tuberculosis occurred in HIV-seronegative persons. Tuberculosis incidence among HIV-seropositive drug users was 3.3, 7.7, 0, and 0.34 per 100 person-years in those with tuberculin reaction sizes of ≥10 mm, 5–9 mm, 1–4 mm, and 0 mm, respectively, and was significantly increased in persons with 5–9 mm induration compared with those with 0–4 mm induration (rate ratio 27.7, 95%CI 2.9–268). Among persons with reaction sizes of 5–9 mm, tuberculosis occurred exclusively in those with CD41 lymphocyte counts <500/mm3 at the time of their 5–9 mm tuberculin reactions.
CONCLUSION: HIV-infected persons with tuberculin reaction sizes of 5–9 mm are at increased risk for tuberculosis compared to non-anergic persons with smaller (0–4 mm) reaction sizes. However, this increased risk may be limited to those with low CD41 lymphocyte counts at the time of tuberculin testing.
Document Type: Regular Paper
Affiliations: 1: Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA and Department of Epidemiology and Social Medicine, Montefiore Medical Center and the Albert Einst 2: Department of Epidemiology and Social Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA and Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and the Albert Einstein Col 3: Department of Epidemiology and Social Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
Publication date: 2001-08-01
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