Am. J. Respir. Crit. Care Med., Volume 164, Number 12, December 2001, 2166-2171

Transmission of Mycobacterium tuberculosis to Contacts of HIV-infected Tuberculosis Patients

ANNA C. C. CARVALHO, KATHRYN DERIEMER, ZOELETE B. NUNES, MARNEILI MARTINS, MARIO COMELLI, ALESSANDRA MARINONI, and AFRNIO L. KRITSKI

Unidade de Pesquisa em Tuberculose, Serviço de Pneumologia, Hospital Universitário Clementino Fraga Filho/Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro, Brazil; Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley, California; and Scuola di Specializzazione in Statistica Sanitaria, Università degli Studi di Pavia, Italy

We assessed the infectiousness of human immunodeficiency virus (HIV)-seropositive and HIV-seronegative individuals with pulmonary tuberculosis (TB) in a prospective cohort study. We enrolled, evaluated, and followed 104 close contacts of HIV-seropositive pulmonary TB patients and 256 close contacts of HIV-seronegative pulmonary TB patients using a standardized questionnaire, symptom review, chest radiograph, HIV serology, and tuberculin skin testing (TST). Contacts were followed for  12 mo. TB infection at enrollment was 27% (28/104) among contacts of HIV-seropositive TB patients and 35% (90/256) among contacts of HIV-seronegative TB patients (odds ratio [OR] = 0.68, 95% confidence interval [CI] 0.41 to 1.12; p = 0.130). TST conversion occurred in 21% (42/ 204) of subjects; 8% (5/63) of contacts of HIV-seropositive index cases and 26% (37/141) of contacts of HIV-seronegative index cases (OR = 0.24, 95% CI 0.09 to 0.65; p = 0.003). TB was diagnosed in nine contacts; eight were contacts of HIV-seronegative index cases. HIV seropositivity in the index case was independently associated with a lower risk of TB infection among contacts, even among household contacts younger than 15 yr of age. Contacts of HIV-seropositive persons with pulmonary TB were less likely to have a positive TST response at 1 yr of follow-up than contacts of HIV-seronegative persons.

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