Tuberculose bij HIV-positieve en HIV-negatieve drugsgebruikers in Amsterdam

To determine and to compare the incidences of active tuberculosis in HIV positive and HIV negative drug users and to describe the main characteristics of the tuberculosis cases.

Design

Prospective.

Setting

Municipal Health Service, Amsterdam, the Netherlands.

Method

Data of the ongoing cohort study of HIV infection in Amsterdam drug users, including HIV serostatus and CD4 cell counts, from 1986 until 1996 were completed with data from the tuberculosis registration of the tuberculosis department of the Amsterdam Municipal Health Service and analysed statistically.

Results

Of 872 participants 24 persons developed culture confirmed tuberculosis during a total follow-up period of 4000 person years (py) (0.6 per 100 py). Nineteen persons were HIV positive (1.54 per 100 py) and 5 HIV negative (0.18 per 100 py). Multivariately, HIV infection and higher age increased the risk of tuberculosis substantially (relative risks 12.9; 95 confidence interval (CI): 3,4-48.8 and 6.8; 95 CI: 1.3-35.0 respectively).

Thirteen of 22 pulmonary tuberculosis cases (59) were detected by half-yearly X-ray screening of the chest. Tuberculosis occurred relatively early in the course of HIV infection at a mean CD4 cell number of 390/μl. All but one patient completed the tuberculosis treatment.

Conclusion

HIV infection increases the risk of active tuberculosis in Amsterdam drug users 13-fold. The incidence of tuberculosis in HIV negative drug users is 6 times higher than that in the overall Amsterdam population. Periodic chest X-ray screening contributes substantially to case-finding of active tuberculosis in Amsterdam drug users.