A minority of tuberculosis cases occurring during HIV care is possibly preventable

Background

It is often recommended to test patients presenting for HIV care for tuberculin skin test reactivity at the initial visit if they have a prior stay in tuberculosis-endemic areas.

Purpose of the Study

To assess whether incident cases of tuberculosis (tb) in our cohort could have been prevented by such testing and subsequent preventive treatment of patients with a positive skin test.

Setting

HIV clinic in northern Europe caring for about 1000 patients. During the observation time preventive treatment was only rarely prescribed.

Methods

File review of all tb cases occurring more than two months after presenting for HIV care during the ten years 2000-2009. Cases were classified as possibly preventable, probably non-preventable or non-preventable based on residence and travel history, strain typing by restriction fragment length polymorphism technique and/or skin test reactivity.

Results

24 cases in 23 patients were identified. 9 (38%) were classified as possibly preventable, 3 (13%) as probably non-preventable and 12 (50%) as non-preventable.

Conclusion

A minority of tb cases occurring during HIV care is preventable by a policy of testing new patients from endemic areas and treating patients with positive skin tests.