Am. J. Respir. Crit. Care Med., Vol 155, No. 1, Jan 1997, 378-381.
Testing for human immunodeficiency virus infection among tuberculosis patients in Los Angeles
SM Asch, AS London, PF Barnes and L Gelberg
Division of General Internal Medicine, Pacific Center for Health Policy and Ethics, University of Southern California School of Medicine, Los Angeles, USA.
To investigate patterns of testing for human immunodeficiency virus (HIV)
infection in tuberculosis patients, we obtained data from the tuberculosis
registry and from medical records of 500 tuberculosis patients in Los
Angeles County. Sixty-three percent of tuberculosis patients were tested
for HIV infection, and multivariate logistic regression analysis revealed
that the likelihood of testing was significantly higher among males,
persons between 20 and 49 yr old, individuals with HIV risk factors, and
patients treated by public health care providers. A minimum of 12% of the
total sample, 2% of females, 2% of those outside the ages of 20 to 49, 7%
of patients without recorded HIV risk factors, and 17% of patients treated
by private practitioners were infected with HIV. These results suggest that
health care providers, particularly private practitioners, do not follow
national recommendations for universal HIV testing of tuberculosis
patients. Instead, HIV testing is preferentially performed on patients
perceived to be at high risk for HIV infection. Because HIV seroprevalence
is at least 2 to 7% in "low-risk" groups, failure to test these patients
may result in significant missed opportunities for diagnosis and treatment
of HIV coinfection.
