Influence of the human immunodeficiency virus in the incidence of tuberculosis in a cohort of intravenous drug users: effectiveness of anti-tuberculosis chemoprophylaxis.

Abstract

SETTING:

A residential program in Barcelona for drug addicts (therapeutic community) admitted between November 1988 and March 1992, and followed until September 1994.

OBJECTIVE:

To study the incidence of tuberculosis as related to the presence of tuberculosis infection and/or human immunodeficiency virus (HIV) infection, and to evaluate the protective effect of chemoprophylaxis with isoniazid.

DESIGN:

Prospective cohort study. Incidence rates were compared using the Chi-square test for cohort studies. The effectiveness of chemoprophylaxis was evaluated by the Kaplan-Meier method at the univariate level, and by logistic regression models and proportional risks analysis at the multivariate level.

RESULTS:

During the study of 361 individuals without previous known tuberculosis or history of anti-tuberculosis chemoprophylaxis, 25 developed tuberculosis, an overall incidence rate of 1.79/100 person-years. For HIV-positive persons, the incidence rate was 3.25/100 person-years, compared with 0.30/100 in those who were HIV-negative (P < 0.05). The highest incidence rates occurred among HIV-positive persons who did not receive chemoprophylaxis and who were either anergic (HIV-positive, purified protein derivative [PPD]-negative, Multitest-negative) or who were infected with Mycobacterium tuberculosis (PPD+), 10.0/100 person-years and 4.64/100 person-years, respectively. Of the 53 persons who received chemoprophylaxis, three developed tuberculosis, an incidence rate of 1.4/100 person-years. In comparison, in the group of 51 patients who were designated to receive chemoprophylaxis but where none was actually taken, 17 developed tuberculosis, an incidence rate of 5.7/100 person-years (P = 0.03).

CONCLUSION:

HIV-infected intravenous drug users, particularly those who are anergic or who are PPD positive, are at increased risk of developing tuberculosis. Anti-tuberculosis chemoprophylaxis proved effective in this population.

• Authors: J M Jansà, J Serrano, J A Caylà, R Vidal, I Ocaña, T Español
• Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 2 Issue 2 Pg. 140-6 (Feb 1998) ISSN: 1027-3719 [Print] France
• PMID: 9580481 (Publication Type: Journal Article)

Chemical References

• Antitubercular Agents
• Isoniazid

Topics

• AIDS-Related Opportunistic Infections (epidemiology, prevention & control)
• Adult
• Antitubercular Agents (therapeutic use)
• Cohort Studies
• Female
• HIV Infections (epidemiology)
• Humans
• Incidence
• Isoniazid (therapeutic use)
• Male
• Multivariate Analysis
• Prospective Studies
• Risk Factors
• Spain (epidemiology)
• Substance Abuse, Intravenous (epidemiology)
• Therapeutic Community
• Tuberculin Test
• Tuberculosis, Pulmonary (epidemiology, prevention & control)