Solera J, López E, Serna E, Vergara L, Martínez-Alfaro E, Sáez L
Unidad de Enfermedades Infecciosas, Hospital General de Albacete.
Med Clin (Barc). 1993 May 15;100(19):725-9.
The aim of this study was to determine the risk of active tuberculosis in intravenous drug addict (IVDA) patients seropositive and seronegative for the HIV.
A retrospective study of a cohort of IVDA males in 2 drug addict detoxication communities was carried out. Patients with tuberculosis, under treatment or chemoprophylaxis for tuberculosis and those with a stay of less than 3 months were excluded. Patients included underwent a serologic study to detect antibodies versus HIV and a Mantoux test with 2 U. PPDRT23. Subjects who were HIV+ with a Mantoux test < 5 mm were given a delayed cutaneous sensitivity test with 7 antigens. The incidence index of tuberculosis was studied. Logistic regression analysis was performed to evaluate the relative risk of tuberculosis in HIV+ controlled by other variables (having been in prison, previous liver disease, country of origin, age, length of IVDA and length of follow up).
Of the 198 patients admitted 132 were included. Forty-seven were HIV+ and 85 HIV-. Fourteen of the former (30%) and 44 of the latter (51%) had a positive reaction to the Mantoux test (OR 0.4; confidence interval 95% 0.18-0.92; p < 0.05). Eight seropositive (17%) patients with a negative Mantoux test presented anergia to the delayed cutaneous sensitivity tests. After a mean follow up of 12.0 +/- 9.0 months, 4 patients out of the 47 HIV+ (8.5% or 6.93 cases/100 individuals/year; CI 95% 0.13-13.72) presented tuberculosis versus none of the 85 HIV- (p < 0.05) patients. Of the 4 patients diagnosed of tuberculosis, the initial reaction to the Mantoux test was negative in 2 (one pulmonary and the other milliar tuberculosis). Two of the 4 patients diagnosed of tuberculosis died.
The risk of active tuberculosis is specially high in HIV seropositive intravenous drug addicts. The response to the Mantoux test has little sensitivity for demonstration of tuberculous infection in HIV seropositive patients.
本研究的目的是确定静脉注射吸毒者（IVDA）中HIV血清学阳性和阴性患者发生活动性结核病的风险。
对两个吸毒者戒毒社区的一组IVDA男性进行回顾性研究。排除患有结核病、正在接受结核病治疗或化学预防的患者以及住院时间少于3个月的患者。纳入的患者接受了血清学研究以检测抗HIV抗体，并进行了2 U的PPDRT23结核菌素试验。结核菌素试验<5 mm的HIV阳性受试者接受了7种抗原的延迟皮肤敏感性试验。研究了结核病的发病率指数。进行逻辑回归分析以评估在控制其他变量（曾入狱、既往肝病、原籍国、年龄、IVDA时长和随访时长）的情况下，HIV阳性患者患结核病的相对风险。
198名入院患者中，132名被纳入研究。其中47名HIV阳性，85名HIV阴性。前者中有14名（30%），后者中有44名（51%）结核菌素试验呈阳性反应（比值比0.4；95%置信区间0.18 - 0.92；p<0.05）。8名结核菌素试验阴性的血清阳性（17%）患者对延迟皮肤敏感性试验无反应。平均随访12.0±9.0个月后，47名HIV阳性患者中有4名（8.5%或6.93例/100人/年；95%置信区间0.13 - 13.72）患结核病，而85名HIV阴性患者中无一例患病（p<0.05）。在4名被诊断为结核病的患者中，2名（1例为肺结核，另1例为粟粒性肺结核）结核菌素试验的初始反应为阴性。4名被诊断为结核病的患者中有2名死亡。
HIV血清学阳性的静脉注射吸毒者发生活动性结核病的风险特别高。结核菌素试验对HIV血清学阳性患者结核感染的检测敏感性较低。
