Effect of pregnancy on the risk of developing active tuberculosis.

In a case-control study, the effect of recent pregnancy on the risk of developing active tuberculosis among women of reproductive age was investigated in Santo Domingo. Human immunodeficiency virus (HIV)-positive and HIV-negative women diagnosed with new-onset tuberculosis (TB) were compared, respectively, with HIV-positive and HIV-negative women without TB with regard to reproductive history, demographic characteristics, and risk factors for HIV infection. In neither HIV-positive nor HIV-negative women was recent pregnancy or childbirth associated with an increased risk of developing active TB. These results fail to confirm earlier suggestions that pregnancy increases the risk that a woman of child-bearing age infected with Mycobacterium tuberculosis will develop active TB.

Screening for active tuberculosis in HIV testing centre.

In industrialised nations HIV-seropositive individuals can be offered skin testing for tuberculosis (TB) and isoniazid prophylaxis, but this approach is neither practicable nor affordable in most developing countries. In Santo Domingo, Dominican Republic, we offered skin testing and a brief clinical examination for active TB to people requesting HIV testing at one centre. 200 newly detected HIV-positive individuals and 200 age and sex-matched HIV-negative ones were compared. 39 (9.7%) of the 400 individuals seeking HIV testing had active TB; 29 were HIV positive and 10 were HIV negative (adjusted odds ratio 3.3, 95% CI 1.3-8.7; p = 0.01). In multivariate analysis, the strongest independent predictors of active TB were 10 mm or more of induration on skin testing, a history of chronic cough, lymphadenopathy, and HIV infection. Of the patients diagnosed with TB, 85% had one or more symptoms readily ascertainable in a brief screening questionnaire. Screening for TB at HIV-testing sites could be an effective approach to early detection of active TB among not just HIV-positive but also HIV-negative people. Integrating screening for TB into HIV testing schemes could help to reduce the spread of TB and allow patients with TB to be diagnosed and treated earlier.

PIP: A relation between tuberculosis (TB) and HIV infection is well established. 20-60% of AIDS patients in developing countries have been found to have or to develop TB. The combined effects of HIV and TB epidemics on the health systems of developing countries is frightening. To check the growing numbers of HIV-associated TB cases, the US Centers for Disease Control and Prevention and the World Health Organization recommended TB skin testing of HIV-positive people. Those found to be dually infected would be offered prophylactic isoniazid. Most developing countries, however, cannot afford such preventive therapy. The authors investigated whether screening for TB infection and disease at HIV-testing sites is an useful approach to TB control in developing countries. The authors offered skin testing and a brief clinical exam for active TB to people requesting HIV testing at one center in Santo Domingo, Dominican Republic. 200 newly detected HIV-positive individuals were subsequently compared against 200 age and sex-matched HIV-negative individuals. 9.7% of the people seeking HIV testing had active TB; 29 were HIV-positive and 10 HIV-negative. Multivariate analysis found the strongest independent predictors of active TB to be 10 mm or more of induration on skin testing, an history of chronic cough, lymphadenopathy, and HIV infection. Of the patients diagnosed with TB, 85% had one or more symptoms readily ascertainable in a brief screening questionnaire. These findings lead the authors to conclude that screening for TB at HIV-testing sites could be an effective approach to early detection of active TB among both HIV-seropositive and HIV-seronegative people. Integrating screening for TB into HIV testing schemes could help reduce the spread of TB and allow patients with TB to be diagnosed and treated earlier.