Results of testing for human immunodeficiency virus infection among recent contacts of infectious tuberculosis cases in the United States.

CONTEXT: Persons with recently acquired latent tuberculosis (TB) infection and human immunodeficiency virus (HIV) co-infection are at high risk of rapid progression to TB disease.

OBJECTIVES: To determine the proportion of close contacts of infectious TB patients tested for HIV, and the results of HIV testing for this group.

DESIGN, SETTING AND SUBJECTS: Review of health department records for all close contacts of 349 patients with culture-positive pulmonary TB aged 15 years or older reported from five study areas in the United States in 1996.

MAIN OUTCOME MEASURES: Proportion of close contacts of TB patients tested for HIV, and rate of HIV infection among close contacts of TB patients.

RESULTS: A total of 1169 close contacts were identified for 349 patients with active pulmonary TB. HIV test results were available for 224 (64%) TB patients and 220 (19%) close contacts. Of the TB patients tested, 164 (73%) were HIV-negative and 60 (27%) were HIV-positive. An equal proportion of close contacts of HIV-positive and -negative TB patients were tested (21% vs. 24%). Of the close contacts tested, 201 (91%) were HIV-negative and 19 (9%) were HIV-positive. Compared with close contacts of HIV-negative TB patients, close contacts of HIV-positive TB patients were more likely to be HIV-positive (53% vs. 2%; P < 0.01). This association was observed for contacts residing in the TB patient household (70% vs. none; P < 0.01), not residing in the TB patient household (20% vs. 4%; P < 0.05), 25-44 years of age (88% vs. 8%; P < 0.01), and > 44 years of age (22% vs. 2%; P < 0.05).

CONCLUSIONS: HIV-positive TB patients and their close contacts may share some of the same risk factors for HIV infection. These findings suggest that the HIV status of the TB patient, in addition to established risk factors for HIV infection, may be an important consideration for prioritizing voluntary HIV counseling and testing efforts among close contacts of infectious TB patients.