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Alto riesgo de tuberculosis activa en usuarios de drogas infectados por el VIH con anergia cutánea

P A Selwyn¹, B M Sckell, P Alcabes

¹Department of Epidemiology and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

|July 22, 1992

Resumen

Los VIH-positivos que se inyectan drogas con anergia cutánea se enfrentan a un alto riesgo de tuberculosis activa. La profilaxis con isoniazida redujo significativamente la incidencia de tuberculosis en los reactores de tuberculina VIH-positivos.

Área de la Ciencia:

Enfermedades infecciosas Enfermedades infecciosas.
Salud Pública La salud pública.
Inmunología Inmunología.

Sus antecedentes:

La tuberculosis (TB) sigue siendo una preocupación significativa para la salud mundial, particularmente entre las poblaciones vulnerables.
La infección por el virus de la inmunodeficiencia humana (VIH) aumenta sustancialmente el riesgo de reactivación y progresión de la TB.
Las personas que se inyectan drogas representan un grupo de alto riesgo tanto para la coinfección por VIH como para la tuberculosis.

Objetivo del estudio:

Determinar la incidencia de TB activa en personas VIH-seropositivas y VIH-seronegativas que se inyectan drogas con anergia cutánea.
Evaluar la efectividad de la quimioprofilaxis de isoniazida en la prevención de la TB entre los usuarios de drogas inyectables con resultados positivos en las pruebas de tuberculina.

Principales métodos:

Un estudio observacional prospectivo se llevó a cabo dentro de un programa de metadona de la ciudad de Nueva York.
Los sujetos se sometieron a pruebas de tuberculina y pruebas cutáneas de hipersensibilidad de tipo retrasado de antígeno múltiple.
La incidencia de la tuberculosis se calculó en función del estado serológico del VIH, la anergia y el tratamiento con isoniazida.

Principales resultados:

Los sujetos anérgicos seropositivos para el VIH tenían una incidencia del 7,6% de TB activa, una tasa comparable a los reactores de tuberculina seropositivos para el VIH no tratados.
La tasa de incidencia de TB activa entre los sujetos anérgicos seropositivos para el VIH fue de 6,6 casos por cada 100 personas-año.
La profilaxis con isoniazida durante 12 meses en reactores de tuberculina seropositivos para el VIH mostró una disminución de la incidencia de TB activa en comparación con las personas no tratadas o parcialmente tratadas.

Conclusiones:

Los usuarios de drogas inyectables seropositivos para el VIH con anergia cutánea corren un alto riesgo de TB activa.
La quimioprofilaxis con isoniazida parece ser efectiva para reducir la incidencia de TB entre los reactores de tuberculina seropositivos para el VIH.
Se recomiendan pruebas cutáneas de rutina y la consideración de la profilaxis con isoniazida para las personas VIH positivas en entornos de alta prevalencia.

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