Risk of development of tuberculosis in HIV-infected patients.

Swaminathan, S.; Ramachandran, R.; Baskaran, G.; Paramasivan, C.N.; Ramanathan, U.; Venkatesan, P.; Prabhakar, R.; Datta, M.

International Journal of Tuberculosis and Lung Disease; 2000; 4; 839-844.          

Objective : To estimate the rate of development of active tuberculosis (TB) in a cohort of human immunodeficiency virus (HIV) positive patients, and to identify the characteristics of these patients.

Design : A total of 175 HIV-positive individuals were recruited from clinics for sexually transmitted diseases and followed up for 31 + 6.8 months. Clinical examinations, chest X-ray, sputum smear for acid-fast bacilli and culture for mycobacteria and HIV serology were performed at the time of registration and repeated periodically.

Results : Seventeen patients had TB at intake and another 24 developed TB during follow-up, giving a breakdown rate of 6.9/100 person-years (p-y) (95% confidence interval [CI] 4.1 - 9.6). The attack rates were similar in tuberculin positive (7.1/100 p-y, 95% CI 3.4-10.8) and negative (6.7/100 p-y, 95% CI 2.6-10.8) patients. There was a trend towards higher mortality in patients who developed TB (10.5/100 p-y, 95% CI 4.8-15.2) compared to those who did not (6.1/100 p-y, 95% CI 3.2-8.8).

Conclusions : The results of this study provide information regarding the high risk of development of active tuberculosis and its associated mortality in HIV-infected persons. The risk of developing TB appears to be equally high in tuberculin positive and negative individuals, suggesting that new infections could play a major role in this susceptible population.

Key words : HIV; tuberculosis; tuberculin reaction; mortality.

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