A PROSPECTIVE-STUDY OF THE RISK OF TUBERCULOSIS AMONG INTRAVENOUS DRUG-USERS WITH HUMAN IMMUNODEFICIENCY VIRUS-INFECTION
A PROSPECTIVE-STUDY OF THE RISK OF TUBERCULOSIS AMONG INTRAVENOUS DRUG-USERS WITH HUMAN IMMUNODEFICIENCY VIRUS-INFECTION
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DOI：
10.1056/nejm198903023200901
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发表时间：
1989-03-02
影响因子：
158.5
通讯作者：
FRIEDLAND, GH
中科院分区：
文献类型：
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作者：
SELWYN, PA;HARTEL, D;FRIEDLAND, GH
为了确定与人类免疫缺陷病毒（HIV）感染相关的活动性肺结核的风险，我们前瞻性地研究了520名参加美沙酮维持治疗计划的静脉吸毒者。对所有受试者进行了阿曲库林皮肤试验和HIV抗体检测。217名HIV血清阳性受试者中有49名（23%）和303名HIV血清阴性受试者中有62名（20%）在进入研究前对纯化蛋白衍生物（PPD）结核菌素皮肤试验呈阳性反应。在随访期间（平均22个月）复查的血清阳性受试者（131例中的15例; 11%）和血清阴性受试者（202例中的26例; 13%）从阴性到阳性的PPD试验转换率相似。在研究期间，8例HIV血清阳性者（4%）发生活动性结核病，而血清阴性者无一例发生活动性结核病（P < 0.002）。8例结核病中有7例发生在PPD试验阳性的HIV血清阳性受试者中（7.9例/100人-年，而PPD试验阴性的血清阳性受试者中为0.3例/100人-年;率比为24.0; P < 0.0001）。我们的结论是，虽然结核感染的患病率和发病率是相似的艾滋病毒血清阳性和艾滋病毒血清阴性静脉吸毒者，活动性结核病的风险升高，只有血清阳性的主题。这些数据还表明，在艾滋病毒感染者结核病最经常的结果从潜伏性结核感染的再激活，我们的研究结果支持积极使用结核病的药物预防艾滋病毒感染和阳性PPD试验的患者的建议。
To determine the risk of active tuberculosis associated with human immunodeficiency virus (HIV) infection, we prospectively studied 520 intravenous drug users enrolled in a methadone-maintenance program. Tuberculin skin testing and testing for HIV antibody were performed in all subjects. Forty-nine of 217 HIV-seropositive subjects (23 percent) and 62 of 303 HIV-seronegative subjects (20 percent) had a positive response to skin testing with purified protein derivative (PPD) tuberculin before entry into the study. The rates of conversion from a negative to a positive PPD test were similar for seropositive subjects (15 of 131; 11 percent) and seronegative subjects (26 of 202; 13 percent) who were retested during the followup period (mean, 22 months). Active tuberculosis developed in eight of the HIV-seropositive subjects (4 pecent) and none of the seronegative subjects during the study period (P < 0.002). Seven of the eight cases of tuberculosis occurred in HIV-seropositive subjects with a prior positive PPD test (7.9 cases per 100 person-years, as compared with 0.3 case per 100 person-years among seropositive subjects without a prior positive PPD test; rate ratio, 24.0; P < 0.0001). We conclude that, although the prevalence and incidence of tuberculous infection were similar for both HIV-seropositive and HIV-seronegative intravenous drug users, the risk of active tuberculosis was elevated only for seropositive subjects. These data also suggest that in HIV-infected persons tuberculosis most often results from the reactivation of latent tuberculous infection; our results lend support to recommendations for the aggressive use of chemoprophylaxis against tuberculosis in patients with HIV infection and a positive PPD test.