Abstract

PIP: In the West, 1 of the most common opportunistic bacterial infections in AIDS patients is Mycobacterium avium-intracellulare (MAI). Physicians have diagnosed it in 15-20% of AIDS patients before they died, and it was identified in 50% of dead AIDS patients. Only 2 cases have been diagnosed in Africa. Before AIDS began afflicting the human population, dissemination of MAI was rare, but in AIDS patients the degree of dissemination is widespread and has been found, at least, in the spleen, lymph nodes, lung, liver, and gastrointestinal (GI) tract. The portal of entry in MAI infections has not been clearly identified, but some evidence suggests that in AIDS patients the disseminated infection enters through the GI tract. Response to antibiotic treatment for MAI in AIDS patients is poor. Other nontuberculous mycobacteria, such as M. kansasii and 1 case of M. leprae, have also been found in association with AIDS. In the United States, tuberculosis is often associated with AIDS, especially if the cases are black, of foreign origin (particularly from Haiti), or had a history of intravenous drug abuse. Tuberculosis in AIDS patients is more likely to be lymphatic and disseminated than pulmonary. 1 study revealed that 30% of AIDS cases with tuberculosis had pulmonary tuberculosis compared with 80% of those with only tuberculosis. Further, pericardial disease commonly accompanies tuberculosis in AIDS patients. The treatment for tuberculosis in AIDS patients is standard antituberculous drugs. It appears that, at least in the case of tuberculosis, HIV infection causes reactivation of latent infections 1st acquired in childhood. Further research on the association of mycobacterial infection and AIDS will lead to a greater understanding of the immune defense system in all types of patients.