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How does tuberculosis relate to HIV positive and HIV negative drug users?
S T Keizer1, M M Langendam, H van Deutekom
1Department for Tuberculosis-control, Amsterdam Municipal Health Service, The Netherlands.
Journal of Epidemiology and Community Health
|February 29, 2000
Summary
HIV infection significantly increases tuberculosis risk in Amsterdam drug users. Regular chest X-rays aid early detection, even in HIV-negative individuals with elevated incidence.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- Drug users represent a vulnerable population for infectious diseases.
- Human Immunodeficiency Virus (HIV) infection is a known risk factor for tuberculosis (TB).
- Understanding TB incidence in specific risk groups is crucial for public health interventions.
Purpose of the Study:
- To compare the incidence of active tuberculosis (TB) in HIV-positive versus HIV-negative drug users.
- To characterize the main features of TB cases within this cohort.
- To assess the impact of HIV on TB risk.
Main Methods:
- Prospective cohort study conducted from 1986 to 1996 in Amsterdam.
- Inclusion of HIV serostatus and CD4-cell counts from an ongoing HIV infection study.
- Integration of data with the Amsterdam Municipal Health Service tuberculosis registry.
- Person-time and survival analysis methods were employed.
Main Results:
- A total of 24 TB cases were diagnosed over 4000 person-years.
- HIV-positive individuals had a 13-fold increased risk of TB (1.54 per 100 py) compared to HIV-negative individuals (0.18 per 100 py).
- TB occurred early in HIV infection (mean CD4 count 390/microliter), with reactivation estimated in two-thirds of HIV-positive cases.
- Half-yearly chest radiographic screening detected 59% of pulmonary TB cases.
Conclusions:
- HIV infection is a major risk factor, increasing active TB risk 13-fold in Amsterdam drug users.
- TB incidence remains significantly elevated in HIV-negative drug users compared to the general population.
- Periodic chest radiographic screening is effective for early TB casefinding in this population, especially in the absence of traditional methods like contact tracing.