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Screening for tuberculosis in an east London HIV clinic
C M Theodore1, G E Forster, B T Goh
1Department of Genitourinary Medicine, Royal London Hospital, UK.
Insights
Routine screening for tuberculosis (TB) in HIV-positive patients using skin tests and chest X-rays is effective. This approach identified 20 out of 144 patients needing treatment or prophylaxis for TB infection.
Area of Science:
- Public Health
- Infectious Diseases
- Immunology
Background:
- Human Immunodeficiency Virus (HIV) infection increases the risk of tuberculosis (TB) reactivation.
- Early detection of TB in HIV-positive individuals is crucial for effective management and prevention of transmission.
- Genitourinary Medicine (GUM) clinics manage a population at risk for both HIV and TB.
Purpose of the Study:
- To evaluate the effectiveness of routine tuberculin skin testing and chest radiography for screening TB in HIV-seropositive patients.
- To determine the prevalence of active and latent TB infection in this cohort.
- To assess the utility of these screening methods in identifying patients requiring treatment or prophylaxis.
Main Methods:
- A prospective study involving 144 consecutive HIV-seropositive patients attending a GUM clinic.
- Tuberculin Tine tests and chest radiographs were performed on all participants.
- Patients were treated for active TB or received prophylaxis based on test results and radiographic findings.
Main Results:
- Twenty out of 144 (13.9%) HIV-seropositive patients were identified with active or previous tuberculous infection.
- Ten patients received treatment for active TB based on radiography and/or positive skin tests.
- An additional ten patients received TB prophylaxis due to radiographic findings or positive skin tests.
Conclusions:
- Routine screening for TB using skin testing and chest radiography is valuable in HIV-seropositive patients.
- This screening strategy has a high detection rate for both active and latent TB.
- Identifying and treating TB in this population is essential for preventing disease progression and reactivation.
Abstract:
A prospective study was carried out to assess the value of routine skin tuberculin testing and chest radiography in HIV seropositive patients, attending the Genitourinary Medicine (GUM) clinic between July 1991-May 1992. 144 consecutive HIV seropositive patients had tuberculin Tine tests and chest radiographs performed. Ten patients were treated for active tuberculosis (TB) on the basis of abnormal radiography with or without strongly positive (Grade 3/4) skin tuberculin tests. A further 10 patients received prophylaxis on the basis of abnormal chest radiography consistent with previous tuberculous infection or strongly positive tuberculin tests. Active or previous tuberculous infection was found in the UK born Caucasian homosexual population as well as in injecting drug users and patients who were born in areas of high TB prevalence. Screening for TB in HIV seropositive patients is important both for detecting asymptomatic tuberculous infection and for recognizing patients at risk for reactivation of latent TB. We showed a high pick-up rate with 20 out of 144 patients having treatment as a result of screening.