TB IN IV DRUG ABUSERS--A THREE-CITY STREET-BASED STUDY

这项多中心研究将在非结核病患者中进行， 从三个社区招募的注射吸毒者 在美国西部： 旧金山弗朗西斯科湾区，波特兰和丹佛。 具体研究目标是确定：（1） 按地区、性别、人种/种族分列的结核分枝杆菌感染， 年龄和HIV感染状况; 结核感染，如结核菌素皮肤试验转换所示; (3)结核病感染的行为和人口相关因素，包括 无家可归、监禁和吸毒模式;（4） 按艾滋病毒状况和免疫水平分列的注射吸毒者皮肤试验无反应情况 抑制（如DC 4+淋巴细胞计数所反映）;和（4）行为 皮肤试验无反应性的相关因素。 本建议书中的三个地点均为 目前正在进行以社区为基础的注射吸毒者研究，其中包括 访谈和艾滋病毒抗体检测;结核病研究将被纳入 这些现有的项目。 在这项为期三年的研究中， 我们将用纯化的蛋白衍生物进行结核菌素皮肤试验， (PPD)1633名符合我们纳入标准的注射吸毒者;所有PPD阴性的注射吸毒者 我将有这个结果确认接受助推器皮肤测试之一 一个月后。 157名感染艾滋病毒的注射吸毒者和一名随机 将对314名HIV阴性的注射吸毒者进行皮试无反应性评价 使用两种标准对照（皮肤癣菌和腮腺炎）; CD 4+淋巴细胞 将在所有HIV阳性受试者中测定计数。 所有PPD阳性 受试者将接受胸部X光检查和其他医学评价 以确定是否存在活动性肺结核，以及（如果不存在）是否 预防性抗结核治疗是必要的。 所有PPD阴性IDUs 将在六个月后接受另一次结核菌素皮肤试验以进行随访 寻找新的M肺结核感染。 PPD阴性受试者来自 弗朗西斯科将在12点后接受额外的结核病筛查， 18个月的随访。 除了满足研究 上述目的，本研究将建立结核病模型 对注射吸毒者和社区中其他难以接触的人群进行检测， 基于设置。

This multi-site study will conduct for tuberculosis (TB) among out-of- treatment injection during users (IDUs) recruited from three communities in the western U.S.: The San Francisco Bay Area, Portland and Denver. Specific research objectives are to determine: (1) The prevalence of Mycobacterium tuberculosis infection by region, gender, race/ethnicity, age and HIV-infection status; (2) The incidence of the new M. tuberculosis infection, as indicated by tuberculin skin test conversions; (3) Behavioral and demographic correlates of TB infection, including homelessness, incarceration and drug use patterns; (4) The prevalence of skin test anergy among IDUs, by HIV-status and level of immune suppression (as reflected in DC4+ lymphocyte count); and (4) Behavioral correlates of skin test anergy. All three sites in this proposal are currently conducting community-based studies of IDUs which include interviews and HIV-antibody testing; studies for TB will be integrated with these existing projects. Over the course of this three-year study, we will perform tuberculin skin tests with purified protein derivative (PPD) on 1633 IDUs who meet our inclusion criteria; all PPD-negative IDUs will have this result confirmed by receiving a booster skin test one month later. One hundred fifty-seven HIV-infected IDUs and a random sample of 314 HIV-negative IDUs will be evaluated for skin test anergy using two standard controls (dermatophyton and mumps); CD4+ lymphocyte counts will be determined on all HIV-positive subjects. All PPD-positive subjects will be referred for chest X-rays and other medical evaluation to determine if active tuberculosis is present and (if not) whether preventive antituberculous therapy is indicated. All PPD-negative IDUs will receive another tuberculin skin test after six months to follow-up to look for new M. tuberculosis infections. PPD-negative subjects from San Francisco will receive additional screening for TB after twelve and eighteen months of follow-up. In addition to meeting the research objectives described above, this study will establish a model for TB testing of IDUs and other difficult-to-access populations in community- based settings.