Coinfection with tuberculosis and HIV-1 in male prison inmates

An association between past exposure to tuberculosis (TB) and infection with human immunodeficiency virus type 1 (HIV-1) was investigated using a case-control design among a 6-week sample of 698 male inmates consecutively admitted to the Maryland State prison system. Based on Mantoux testing and measurement of anti-HIV-1, we found a positive but not significant association between HIV-1 and TB infection (odds ratio 2.4, 95 percent confidence interval 0.9-6.3). The power of the study to detect an association of this magnitude was 0.57. Of the entire intake sample, 1.3 percent were found to be coinfected with TB and HIV-1. Some misclassification may have been present due to anergy or latent HIV-1 infection. The elevated risk of TB in coinfected inmates, coupled with the study results, suggest that the inmate screening process on entry to the prison should be modified to improve identification of coinfected people. Specifically, anergy testing should be added to the admission screening procedure, and appropriate voluntary anonymous HIV-1 antibody testing should be more widely available to inmates.