TB prevention in HIV clinics in New York City
OBJECTIVE: To evaluate tuberculosis (TB) prevention in HIV clinics based on the prevalence and incidence of TB and the efficacy of preventive therapy with isoniazid (INH).
DESIGN: The medical records of 2393 HIV-infected patients with a first clinic visit in 1995 were reviewed retrospectively. Deaths and TB cases through December 1997 were ascertained through a match with the TB and AIDS registries.
RESULTS: At first visit, 92 patients (4%) had a history of TB, 98 (4%) were being treated for TB, and six (<1%) were diagnosed with TB. During follow-up, 23 cases were diagnosed, an incidence of 0.53 per 100 person-years (py) (95%CI 0.34–0.77). Among 439 tuberculin skin test (TST) positive patients, the incidence of TB/100 py was 1.63 (95%CI 0.27–5.02) in patients with no INH, 1.28 (95%CI 0.40–2.98) in patients with <12 months of INH, and 1.06 (95%CI 0.38–2.28) in patients with 12 months of INH. The incidence/100 py was 0.0 (95%CI 0.0–0.78) in TST-negative patients and 0.37 (95%CI 0.09–0.95) in anergic patients. The relative risk of TB was 0.65 (95%CI 0.14–4.56) in TST-positive patients with 12 months of INH (vs. none).
CONCLUSIONS: The benefits of TB prevention efforts in these HIV clinics from 1995 to 1997 were limited because most TB occurred before the first clinic visit. Methods for reaching HIV-infected patients earlier should be identified.
Keywords: HIV infection; prevention; tuberculosis
Document Type: Regular Paper
Affiliations: 1: New York City Department of Health, Office of AIDS Research, New York, New York 2: Division of Tuberculosis Elimination, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Publication date: 01 February 2001
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