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Document 1088
DOCN M9651088
TI Tuberculosis infection in human immunodeficiency virus-positive
adolescents and young adults: a New York City cohort.
DT 9505
AU Hoffman ND; Kelly C; Futterman D; Adolescent AIDS Program, Montefiore
Medical Center, Bronx, NY; 10467, USA.
SO Pediatrics. 1996 Feb;97(2):198-203. Unique Identifier : AIDSLINE
MED/96160384
AB OBJECTIVES: Adolescents with human immunodeficiency virus (HIV)
infection are at increased risk for tuberculosis (TB), underscoring the
importance of early identification of TB infection. The goals of this
study were to assess the factors associated with the completion of
evaluations for TB in a cohort of HIV-positive adolescents and young
adults and to describe the prevalence of Mycobacterium tuberculosis
infection and adherence to antituberculous treatment regimens. METHODS:
A retrospective chart review was done for all HIV-positive adolescents
and young adults, ages 13 to 21 years (n = 49), seen in a comprehensive
care program from January 1991 through December 1992. Data collected
included CD4 cell count, HIV clinical status, living situation,
substance use history, and the completion of an annual evaluation for TB
infection. The evaluation consisted of a tuberculin skin test (Mantoux
test), using an intraepidermal injection of 0.1 mL of 5 tuberculin units
of purified protein derivative (PPD) and a simultaneous Merieux
multitest anergy panel. Chi-square analysis was used to assess the
association between the completion of the evaluation for TB and both
living status and substance use. RESULTS: Thirty-one (63%) of 49
patients completed evaluations for TB. Of the 31 completed evaluations,
18 were assessed by clinic staff on site, and 13 were assessed by other
medical or trained nonmedical observers through community networking
efforts. Neither homelessness nor illicit substance use were factors in
the completion of the evaluation. Six (19%) of the 31 patients had
positive PPD skin test results. Three had medical histories and chest
radiographs suggesting active TB, and all were hospitalized for at least
2 weeks. Two had positive cultures for M tuberculosis, although the
third also responded clinically to antituberculous therapy. All three
were otherwise asymptomatic for HIV infection, with only moderately
depressed CD4 cell counts. All three were homeless and used crack
cocaine. After the initial treatment as inpatients, none completed
treatment within the prescribed time period. CONCLUSIONS: The
completions of the evaluations for TB were greatly facilitated by
community networking, but innovative strategies to enhance both
screening and treatment programs, such as training youth service
providers in the community to read PPD skin tests, expansion of directly
observed therapy services, and youth-centered programs for housing and
substance use, need further development. The high prevalence of TB in
the cohort underscores the need for providers to increase efforts to
identify cases of TB infection among adolescents and young adults and to
incorporate HIV risk assessment, counseling, and testing into their
practices routinely.
DE Adolescence Adult Cohort Studies Female Homeless Persons Human HIV
Seropositivity/*COMPLICATIONS/EPIDEMIOLOGY Male New York
City/EPIDEMIOLOGY Retrospective Studies Support, Non-U.S. Gov't
Support, U.S. Gov't, P.H.S. Tuberculosis/*COMPLICATIONS/EPIDEMIOLOGY
JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).