Two-step tuberculin skin testing of injection drug users recruited from community-based settings

A. R. Lifson, S. M. Grant, J. Lorvick, F. D. Pinto, H. He, S. Thompson, E. G. Keudell, M. J. Stark, R. E. Booth, J. K. Watters

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


SETTING: Cross-sectional study of drug users recruited from street-based settings in four US cities: Denver, Portland, Oakland and San Francisco. OBJECTIVE: To evaluate responses to two-step tuberculin skin testing among HIV-positive and HIV-negative injection drug users. DESIGN: Subjects were recruited from existing studies of HIV and risk behaviors for tuberculin skin testing. Those with a negative initial tuberculin test were referred for a second skin test 1-3 weeks later. A positive tuberculin test was defined as ≥10 mm, or ≥5 mm if the subject was HIV-positive. RESULTS: Of 997 persons receiving an initial tuberculin test, 13% had a positive response. Of 644 persons receiving a second tuberculin test, 8% had a positive response, with rates as high as 14% among those from Oakland and 12% among African Americans. HIV-positive subjects were less likely to have skin test responses ≥10 mm on the initial test (P = 0.03), or increases between the initial and second test of ≥10 mm (P = 0.06). CONCLUSION: Boosting occurred in both HIV-positive and HIV-negative injection drug users. Two-step testing should be considered for this population, particularly those on whom repeat tuberculin testing will be performed.

Original languageEnglish (US)
Pages (from-to)128-134
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number2
StatePublished - 1997


  • Booster effect
  • HIV
  • Injection drug users
  • Tuberculin testing
  • Two-step testing


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