Katz D J, Hall W N, Keon N B, Crane L R
Disease Surveillance Section, Michigan Department of Public Health, Lansing.
Am Rev Respir Dis. 1993 May;147(5):1283-6. doi: 10.1164/ajrccm/147.5.1283.
The epidemic of human immunodeficiency virus (HIV) disease has contributed to the resurgence of tuberculosis in the United States. For clinical and public health reasons, the Advisory Council for the Elimination of Tuberculosis has recommended that all patients with tuberculosis be tested for HIV antibodies. We reviewed the medical records of all patients with tuberculosis in whom a diagnosis was made at a Detroit medical center from July 1, 1986 to June 30, 1990, before and after recommendations were issued. Of 195 patients, 69 (35.4%) were tested for HIV antibodies: 73.7% of 57 patients whose medical records documented risk behaviors for HIV infection, and 19.6% of 138 patients who denied high-risk behaviors or whose medical records contained no risk information (relative risk of testing among patients with documented risk factors compared with others, 3.8; 95% confidence interval, 2.6 to 5.5). Testing of patients who denied risk behaviors or had no information in their records increased from 14.9% in the first 12 months to 30.4% in the last (p = 0.08, test for trend). In this population, national recommendations appear to have stimulated HIV testing, although most patients still are not being tested.
人类免疫缺陷病毒（HIV）疾病的流行导致美国结核病再度抬头。出于临床和公共卫生方面的原因，消除结核病咨询委员会建议对所有结核病患者进行HIV抗体检测。我们查阅了底特律一家医疗中心在1986年7月1日至1990年6月30日期间确诊的所有结核病患者的病历，这一时间段恰好在相关建议发布前后。在195名患者中，69名（35.4%）接受了HIV抗体检测：在病历记录有HIV感染风险行为的57名患者中，73.7%接受了检测；在否认有高危行为或病历中无风险信息的138名患者中，19.6%接受了检测（有记录风险因素的患者与其他患者相比，检测的相对风险为3.8；95%置信区间为2.6至5.5）。否认有风险行为或病历中无相关信息的患者的检测率从最初12个月的14.9%上升至最后12个月的30.4%（趋势检验，p = 0.08）。在这一人群中，尽管大多数患者仍未接受检测，但全国性建议似乎推动了HIV检测。
