Human immunodeficiency virus testing in patients with newly-diagnosed tuberculosis in Singapore

Introduction : Infection with human immunodeficiency virus (HIV) is the most well-known risk factor for the development of tuberculosis (TB). The joint statement by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America recommends that all patients with TB undergo testing for HIV infection after counselling. We looked at physician compliance with this recommendation in Singapore. Methods: A retrospective review of the case records of all patients diagnosed with microbiologically-proven TB between September 2005 and December 2006 (inclusive) at the Singapore General Hospital was conducted. Results: Between September 2005 and December 2006, 493 patients were diagnosed with tuberculosis at our institution. HIV testing was performed in 184 patients (37.3 percent), of whom 15 (8.2 percent) was seropositive. Univariate analysis showed that an age equal to or younger than 60 years, male gender, non-pulmonary tuberculosis, inpatient location at diagnosis, and having an infectious diseases physician as the attending doctor were all significantly associated with HIV testing (p-value is less than 0.05). Conclusion: Compliance with HIV testing in all newly-diagnosed tuberculosis patients is poor, with less than 40 percent of patients being tested at our institution. We need to address the factors associated with failure to test, and reinforce to our physicians the importance of HIV testing in these patients.