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1994-08-27
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Document 0727
DOCN M9480727
TI HIV and tuberculosis infection in San Francisco's homeless adults.
Prevalence and risk factors in a representative sample.
DT 9410
AU Zolopa AR; Hahn JA; Gorter R; Miranda J; Wlodarczyk D; Peterson J;
Pilote L; Moss AR; Department of Epidemiology and Biostatistics,
University of; California-San Francisco 94143-1347.
SO JAMA. 1994 Aug 10;272(6):455-61. Unique Identifier : AIDSLINE
MED/94315724
AB OBJECTIVE--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. DESIGN--Cross-sectional study. SETTING--Inner-city shelters and
free meal programs. PARTICIPANTS--A representative sample of 1226 adults
(> or = 18 years) were enrolled from community sites. MAIN OUTCOME
MEASURES--Serum HIV-1 antibody status and tuberculin skin test
reactivity. RESULTS--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.
CONCLUSIONS--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.
DE Adult Comorbidity Cross-Sectional Studies Female Homeless
Persons/*STATISTICS & NUMER DATA Human HIV Infections/*EPIDEMIOLOGY
HIV Seroprevalence/TRENDS Logistic Models Male Middle Age
Multivariate Analysis Odds Ratio Prevalence Risk Factors San
Francisco/EPIDEMIOLOGY Support, Non-U.S. Gov't Support, U.S. Gov't,
P.H.S. Tuberculin Test Tuberculosis/*EPIDEMIOLOGY JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).