Document 0823
 DOCN  M9650823
 TI    Tuberculosis infection in human immunodeficiency virus-positive
       adolescents and young adults: a New York City cohort.
 DT    9605
 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
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