Background: In adults with Mycobacterium tuberculosis infection, the strongest known risk factor for development of active tuberculosis (TB) is human immunodeficiency virus (HIV) infection. Prison inmates who develop active TB can transmit disease to other inmates, staff, and into the communities where they are released. In August 1999, an inmate from a prison dormitory (Dormitory A) for 250 HIV-positive men was diagnosed with infectious pulmonary TB. Methods: We interviewed case-patients, reviewed medical records and compared the DNA fingerprints of isolates. Tuberculin skin testing (TST) of inmates was conducted in September 1999 with follow-up testing in December 1999. We documented viral loads and CD4+ counts for inmates in Dormitory A. Results: Of 324 men in Dormitory A between May 1-September 30, 1999, 30 developed active TB. Isolates were sensitive to all drugs tested; all fourteen isolates tested to date have matching DNA fingerprint patterns. Twenty-six (87%) of 30 case-patients resided in Dormitory A's right wing: 76/117 (65%) inmates from the right wing and 19/135 (14%) from the left wing converted to positive TSTs (Relative Risk [RR]=4.4; 95% Confidence Interval [CI]=2.4-6.8). Sixty-six men had previous positive TSTs; 6 were released prior to testing. Case-patients were more likely to have CD4+ counts <200 compared to TST convertors (RR=2.4; CI=1.4-4.2). Increased viral loads were not associated with development of active TB. Conclusions: We documented extensive transmission of M. tuberculosis among HIV-infected inmates. Screening, diagnosis, and treatment for tuberculosis is critical in incarcerated populations, especially those infected with HIV.
Learning Objectives: 1. Discuss factors which contribute to the increased risk of infection with Mycobacterium tuberculosis in prison settings. 2. Describe the risk factors associated with development of active tuberculosis. 3. List three principles of screening for detecting latent TB infection in persons infected with the Human Immunodeficiency Virus
Keywords: HIV/AIDS, Tuberculosis
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.