TB prevention in HIV clinics in New York City.

SETTING

Ten hospital-based human immunodeficiency virus (HIV) clinics in New York City.

OBJECTIVE

To evaluate tuberculosis (TB) prevention in HIV clinics based on the prevalence and incidence of TB and the efficacy of preventive therapy with isoniazid (INH).

DESIGN

The medical records of 2393 HIV-infected patients with a first clinic visit in 1995 were reviewed retrospectively. Deaths and TB cases through December 1997 were ascertained through a match with the TB and AIDS registries.

RESULTS

At first visit, 92 patients (4%) had a history of TB, 98 (4%) were being treated for TB, and six (<1%) were diagnosed with TB. During follow-up, 23 cases were diagnosed, an incidence of 0.53 per 100 person-years (py) (95%CI 0.34-0.77). Among 439 tuberculin skin test (TST) positive patients, the incidence of TB/100 py was 1.63 (95%CI 0.27-5.02) in patients with no INH, 1.28 (95%CI 0.40-2.98) in patients with <12 months of INH, and 1.06 (95%CI 0.38-2.28) in patients with 12 months of INH. The incidence/100 py was 0.0 (95%CI 0.0-0.78) in TST-negative patients and 0.37 (95%CI 0.09-0.95) in anergic patients. The relative risk of TB was 0.65 (95%CI 0.14-4.56) in TST-positive patients with 12 months of INH (vs. none).

CONCLUSIONS

The benefits of TB prevention efforts in these HIV clinics from 1995 to 1997 were limited because most TB occurred before the first clinic visit. Methods for reaching HIV-infected patients earlier should be identified.