Zolopa A R, Hahn J A, Gorter R, Miranda J, Wlodarczyk D, Peterson J, Pilote L, Moss A R
Department of Epidemiology and Biostatistics, University of California-San Francisco 94143-1347.
JAMA. 1994 Aug 10;272(6):455-61.
To determine the prevalence and risk factors for human immunodeficiency virus (HIV) and tuberculosis (TB) infection and investigate the relationship between these two infections in homeless adults.
Cross-sectional study.
Inner-city shelters and free meal programs.
A representative sample of 1226 adults (> or = 18 years) were enrolled from community sites.
Serum HIV-1 antibody status and tuberculin skin test reactivity.
Human immunodeficiency virus seroprevalence was 8.5% (95% confidence interval [CI], 7.0% to 10.1%) and the prevalence of TB infection was 32% (95% CI, 30% to 37%). Nineteen percent of the HIV-seropositive subjects had positive tuberculin skin tests. Independent risk factors for HIV infection included younger age, black race, male homosexual contact, injection drug use, use of injection drugs in shooting galleries, and selling sex. Tuberculosis infection was associated with the duration of homelessness and living in crowded shelters or single-room-occupancy hotels. Injection drug use, a risk factor for HIV, was also a risk factor for TB, with a particularly strong association in women. No evidence of an association between TB and HIV infection was found, even after accounting for anergy.
The homeless population in the United States should be considered a group at high risk for HIV infection and TB. Given the constellation of risk factors present, the high prevalence of infection, and lack of access to medical services, we anticipate that these communicable diseases in this population will represent a growing public health problem.
确定人类免疫缺陷病毒（HIV）和结核病（TB）感染的患病率及危险因素，并调查无家可归成年人中这两种感染之间的关系。
横断面研究。
市中心收容所和免费膳食项目。
从社区场所招募了1226名成年人（≥18岁）的代表性样本。
血清HIV-1抗体状态和结核菌素皮肤试验反应性。
人类免疫缺陷病毒血清阳性率为8.5%（95%置信区间[CI]，7.0%至10.1%），结核感染患病率为32%（95%CI，30%至37%）。19%的HIV血清阳性受试者结核菌素皮肤试验呈阳性。HIV感染的独立危险因素包括年龄较小、黑人种族、男性同性恋接触、注射吸毒、在射击场使用注射毒品以及卖淫。结核感染与无家可归的持续时间以及居住在拥挤的收容所或单人居住酒店有关。注射吸毒是HIV的一个危险因素，也是TB的一个危险因素，在女性中关联尤为强烈。即使在考虑无反应性之后，也未发现TB与HIV感染之间存在关联的证据。
美国的无家可归人群应被视为HIV感染和TB的高危群体。鉴于存在的一系列危险因素、感染的高患病率以及无法获得医疗服务，我们预计该人群中的这些传染病将成为一个日益严重的公共卫生问题。
