Tuberculin skin testing and the HIV epidemic.

Tuberculosis (TB) cases in the United States have steadily increased in number since 1985. Much of this increase appears attributable to the human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) epidemic, with TB occurring both in those HIV-infected persons with latent as well as recently acquired TB infection. 1 Infection with HIV now is recognized as the most important risk factor for progression from tuberculous infection to active disease. The annual risk of disease in persons dually infected with TB and HIV is 7% to 10%, considerably greater than the 10% lifetime risk in HIV-uninfected tuberculin reactors. 1,2 See also p 369. As a result of the increasing TB morbidity associated with HIV, screening for tuberculous infection now is recommended practice for all patients with HIV infection as well as patients in drug treatment centers, sexually transmitted disease clinics, and HIV/AIDS clinics. 1 Treatment of TB-infected persons with isoniazid can

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