HIV testing in patients with tuberculosis. Physician response to national recommendations

The epidemic of human immunodeficiency virus (HIV) disease has contributed to the resurgence of tuberculosis in the United States. For clinical and public health reasons, the Advisory Council for the Elimination of Tuberculosis has recommended that all patients with tuberculosis be tested for HIV antibodies. We reviewed the medical records of all patients with tuberculosis in whom a diagnosis was made at a Detroit medical center from July 1, 1986 to June 30, 1990, before and after recommendations were issued. Of 195 patients, 69 (35.4%) were tested for HIV antibodies: 73.7% of 57 patients whose medical records documented risk behaviors for HIV infection, and 19.6% of 138 patients who denied high-risk behaviors or whose medical records contained no risk information (relative risk of testing among patients with documented risk factors compared with others, 3.8; 95% confidence interval, 2.6 to 5.5). Testing of patients who denied risk behaviors or had no information in their records increased from 14.9% in the first 12 months to 30.4% in the last (p = 0.08, test for trend). In this population, national recommendations appear to have stimulated HIV testing, although most patients still are not being tested.