Injection Drug Use Is Associated With Tuberculosis Among People With HIV

HIV and tuberculosis (TB) are important and linked causes of morbidity and mortality worldwide. People with injection drug use (PWID) are at risk for HIV infection, but less is known about their risk for TB. Investigators used public health data from the United Kingdom to investigate the association of injection drug use with TB among adults living with HIV.

• Between 2000 and 2014, 102,202 adults were diagnosed with HIV, among whom 5649 (6%) also had TB.
• The overall TB incidence was 344/100,000 person-years (PY). The incidence among PWID was significantly higher: for the men, it was 876/100,000 PY, and for women, 605/100,000 PY.
• In multivariable analysis, compared with men who have sex with men, PWID had increased rates of TB (incidence rate ratio [IRR] for men 5.47, for women 4.59). The only other demographic group with a comparable rate was black Africans born in high-incidence countries (IRR, 4.27).

Comments: As with any observational study, association does not establish causation. It is possible that this association is due to other unmeasured factors; a few that come to mind are smoking, living conditions, and past incarceration. Nevertheless, this study shows that PWID are at higher risk for TB and should be targeted for screening.

Darius A. Rastegar, MD

Reference: Winter JR, Stagg HR, Smith CJ, et al. Injecting drug use predicts active tuberculosis in a national cohort of people living with HIV. AIDS. 2017;31(17):2403-2413.