Street-outreach improves detection but not referral for drug users with latent tuberculosis, New York City.

Street outreach in two New York City communities, Harlem and the South Bronx, between May 2001 and March 2003, provided tuberculin skin test (TST) screening to illicit drug users outside the traditional health care system. Persons who used heroin, cocaine, and/or crack were offered a TST, incentives to return for TST reading, and further evaluation if TST was positive. Of 809 participants, 530 (66%) accepted a TST and 81% (429/530) returned for TST reading. Of 429 participants, 40 (9%) were TST positive. Participants found TST positive did not differ from those found TST negative in previous drug user treatment or drug use practices including snorting heroin, sniffing cocaine, smoking crack, and injecting drugs of any kind. Of the 40 participants found TST positive, the 21 who tested TST positive for the first time were more likely to be male (p = .03) and noninjectors (p = .02), than the 19 who had tested TST positive in the past. Only two newly identified persons pursued follow-up care. Street recruitment expanded testing. Better follow-up strategies are needed. The study's limitations are noted.

Factors that complicate the treatment of tuberculosis in HIV-infected patients.

Treatment of tuberculosis (TB) in persons coinfected with HIV has become increasingly complex during the past decade. We describe the factors that complicate anti-TB therapy in a large observational cohort of HIV-infected persons in the United States. Among 367 HIV-infected patients with 372 episodes of culture-confirmed TB, 44.1% had injection drug use as a mode of HIV transmission. Hepatic disease was present at the time of TB diagnosis or during anti-TB therapy for 91 episodes (24.5%). Elevation at least twice the upper limits of normal of aminotransaminases was observed during the first month of anti-TB therapy in 116 (31.2%) of the episodes. The most commonly reported adverse effects occurring during therapy were rash (27.8%), nausea (26.2%), leukopenia or neutropenia (20.2%), diarrhea (19.3%), vomiting (18.5%), and elevated temperature (>101.5 degrees F [38.6 degrees C], 16.9%). Prescription of a rifamycin and a medication known to interact with rifamycins occurred during 270 (72.6%) episodes. Because HIV-infected patients with TB often have underlying complicating conditions, such as hepatic disease, and are treated with medications that may have toxicities and cause drug-drug interactions, we recommend that clinicians pay careful attention to these factors when treating coinfected patients.