Abstract

PIP: Worldwide, approximately 1.7 billion persons are infected with M. tuberculosis, and 5 million with HIV. In developing countries, a strong association exists between the 2 pathogens, with 14-30% of AIDS patients having tuberculosis (TB), and 12-60% of TB patients HIV-seropositive (HIV+). TB is one of the most frequent opportunistic infection in AIDS, and is a common way for AIDS to present. Evidence suggests that most TB cases in HIV+ patients are due to the endogenous reactivation of past TB infection instead of from new exogenous infection. Particular cause for concern exists in developing countries where approximately 1/2 of the population aged 20-40 years is infected with TB. While 10% of HIV-individuals may develop TB over their lifetimes, HIV+ individuals are at far greater risk of developing the disease. The paper discusses diagnosis, chemoprophylaxis, and treatment of TB. To help stymie major increases in TB patients as HIV spreads across populations with high prevalence of TB, the authors recommend offering HIV testing and counseling to all patients, including TB in the differential diagnoses of all pulmonary diseases in HIV+ patients, offering BCG vaccination to every nonsymptomatic AIDS newborn in countries with high levels of TB infection, routinely obtaining mycobacterial stains and cultures on specimens from HIV+ patients with respiratory symptoms, making clinicians aware of the many false negative tuberculin tests and atypical radiographic patterns in advanced HIV infection, offering 12 months of isoniazid chemoprophylaxis to those HIV+, treating HIV patients with TB with isoniazid, rifampicin, and 1 or 2 of pyrazinamide, ethambutol, or streptomycin during the 1st 2 months, and making health workers aware of infection risks from doing tuberculin tests and injecting streptomycin.