MYCOBACTERIUM TUBERCULOSIS INFECTION IN DRUG USERS

申请人摘要：结核病在纽约吸毒者中流行 约克市和其他地方。 准确识别吸毒者 潜伏M.结核病感染，以确定是否有资格 化学预防，从而防止活性的发展， 结核病是一项重要的公共卫生目标。 这项研究涉及 一些悬而未决的问题，目前站在方式 实现这一目标。 M的危险因素结核病的感染还不完全清楚。 因此，目前的干预措施不能针对最高层的人， 感染的风险。 此外，许多因素降低了可靠性 吸毒者对结核菌素皮肤试验的反应，包括艾滋病毒 感染，营养不良，可能还有吸毒本身。 数据不足 支持目前的建议，即对结核菌素的反应较小， 艾滋病毒血清反应阳性的人比血清反应阴性的人检测， 作为M的指示接受。肺结核感染。 前瞻性数据 需要了解艾滋病毒感染、吸毒和 皮肤试验反应的其他相关因素，并确定最 吸毒者结核菌素试验反应的适当分界点 无论是否感染艾滋病毒。 皮肤无反应被认为是一个适应症的化学预防， 许多艾滋病毒血清反应呈阳性的吸毒者。 然而， 这种情况在很大程度上是不确定的，阻碍了对它的解释。 在临床环境中。 关于这两个问题仍然没有答案。 药物预防在高危人群中的毒性 肝毒性药物的影响及其疗效。 我们建议通过前瞻性研究吸毒者来解决这些问题 目前或以前参加过艾滋病毒感染者和未感染者 物质滥用治疗计划（SAP）在纽约州布朗克斯。 吸毒者 在一项正在进行的艾滋病毒感染队列研究中， 结核病研究。 在半年一次的研究访问中，结核菌素和无反应性测试 将进行，并对有关风险因素的访谈数据进行分析， 结核感染和无反应性将被收集。 风险率 结核菌素转化和发展无反应性的因素将是 定义了 最准确地反映M.结核 将确定该人群的感染情况。 的发生率 结核病和异烟肼毒性 化学预防将与符合条件的患者的比率进行比较， 接受或完成SAP现场主要药物预防 护理诊所 这些数据将加强对吸毒者的识别， 用于化学预防，并更好地描述 在这一高危人群中进行预防。

APPLICANT'S ABSTRACT: Tuberculosis is epidemic among drug users in New York City and elsewhere. Accurate identification of drug users with latent M. tuberculosis infection, to determine eligibility for chemoprophylaxis and thereby to prevent the development of active tuberculosis, is a critical public health goal. This study addresses a number of unanswered questions which currently stand in the way of attaining this goal. Risk factors for M. tuberculosis infection are incompletely understood. Interventions therefore presently cannot be tailored to those at highest risk of infection. In addition, many factors diminish the reliability of drug users' responses to the tuberculin skin test, including HIV infection, poor nutrition, and possibly, drug use itself. Scant data support the current recommendation that a smaller reaction to tuberculin testing in HIV seropositive than in seronegative persons should be accepted as indicative of M. tuberculosis infection. Prospective data are needed to understand the influence of HIV infection, drug use and other related factors on skin test responses and to determine the most appropriate cutpoint for reactions to tuberculin testing for drug users with and with out HIV infection. Cutaneous anergy is considered an indication for chemoprophylaxis for many HIV-seropositive drug users. Yet the risks for and dynamics of this condition are largely uncharacterized, hindering its interpretation in clinical settings. Unanswered questions remain concerning both the toxicity of chemoprophylaxis in drug users at high risk for adverse effects of hepatotoxic medications, and its efficacy. We propose to address these issues by studying prospectively drug users with and without HIV infection currently or formerly enrolled in a substance abuse treatment program (SAP) in the Bronx, NY. Drug users in an ongoing cohort study of HIV infection will be recruited into the TB study. At semiannual research visits, tuberculin and anergy testing will be performed, and interview data regarding risk factors for tuberculosis infection and anergy will be collected. Rates of and risk factors for tuberculin conversion and development of anergy will be defined. The cutpoint most accurately reflecting M. tuberculosis infection in this population will be determined. The incidence of tuberculosis and isoniazed toxicity in patients receiving chemoprophylaxis will be compared to rates in eligible patients not receiving or completing chemoprophylaxis in the SAP's on-site primary care clinic. These data will enhance identification of drug users who are candidates for chemoprophylaxis, and better characterize the risks and benefits of such prophylaxis in this high-risk population.