Document 0068
 DOCN  M95A0068
 TI    Risk factors for tuberculosis in HIV-infected persons. A prospective
       cohort study. The Gruppo Italiano di Studio Tubercolosi e AIDS (GISTA).
 DT    9510
 AU    Antonucci G; Girardi E; Raviglione MC; Ippolito G; Centro di Riferimento
       AIDS, Ospedale L. Spallanzani, Rome, Italy.
 SO    JAMA. 1995 Jul 12;274(2):143-8. Unique Identifier : AIDSLINE
       MED/95319026
 AB    OBJECTIVE--To analyze how demographic, clinical, and laboratory
       characteristics influence the risk of tuberculosis in human
       immunodeficiency virus (HIV)-infected individuals; to examine the
       incidence of tuberculosis associated with change in skin test
       responsiveness in HIV-infected, tuberculin-negative, nonanergic
       individuals. DESIGN--Multicenter cohort study. SETTING--Twenty-three
       infectious disease units in public hospitals in Italy. SUBJECTS--A
       consecutive sample of 3397 HIV-infected subjects were considered for
       entry in the study. Of these, 2695 who were followed up for at least 4
       weeks were enrolled in the study; 739 subjects (27.4%) were unavailable
       for follow-up. The median duration of follow-up was 91 weeks. MAIN
       OUTCOME MEASURE--Culture-proven tuberculosis. RESULTS--Eighty-three
       episodes of tuberculosis were observed. Incidence rates of tuberculosis
       were 5.42 per 100 person-years among tuberculin-positive subjects, 3.00
       per 100 person-years among anergic subjects, and 0.45 per 100
       person-years among tuberculin-negative nonanergic subjects. In
       multivariate analysis, being tuberculin-positive (hazard ratio [HR],
       9.94; 95% confidence interval [CI], 3.84 to 25.72) or anergic (HR, 3.35;
       95% CI, 1.40 to 8.00), or having a CD4+ lymphocyte count less than 0.20
       x 10(9)/L (HR, 4.87; 95% CI, 2.35 to 10.11) or between 0.20 and 0.35 x
       10(9)/L (HR, 2.35; 95% CI, 1.09 to 5.05) were statistically
       significantly associated with the risk of tuberculosis. Incidence of
       tuberculosis increased with decreasing levels of CD4+ lymphocytes in the
       three groups of subjects with different skin test responsiveness. Skin
       tests were repeated 1 year after enrollment in 604 tuberculin-negative
       nonanergic subjects; three case of tuberculosis were observed among the
       13 subjects who converted to tuberculin reactivity. CONCLUSIONS--Risk of
       tuberculosis in HIV-infected persons can be more precisely quantified by
       jointly considering skin test reactivity and CD4+ lymphocyte count.
       Periodic skin tests in tuberculin-negative nonanergic individuals can be
       useful in identifying individuals at high risk of active tuberculosis.
 DE    Adult  AIDS-Related Opportunistic Infections/*EPIDEMIOLOGY  Cohort
       Studies  CD4 Lymphocyte Count  Female  Human  HIV
       Infections/*IMMUNOLOGY/PHYSIOPATHOLOGY  Incidence  Male  Middle Age
       Multivariate Analysis  Proportional Hazards Models  Prospective Studies
       Regression Analysis  Risk Factors  Support, Non-U.S. Gov't  *Tuberculin
       Test  Tuberculosis/DIAGNOSIS/*EPIDEMIOLOGY  JOURNAL ARTICLE  MULTICENTER
       STUDY

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).