Tuberculosis and AIDS

Regional Tuberculosis Centre, Dulwich Public Health Laboratory and Department of Medical Microbiology, King's College School of Medicine and Dentistry, East Dulwich Grove, London SE22 8QF * Department of Genito-Urinary Medicine, King's College School of Medicine and Dentistry, Bessemer Road, London SE5 9PJ Received January 27, 1995 Accepted February 20, 1995 Surmmary: Since the mid-1980s, the rate of decline in reported cases of tuberculosis (TB) has reached a plateau or reversed because of a combination of poverty and increased homelessness, immigration and displacement, poorly managed and supplied TB control programmes and, particularly in the developing world, the emergence of human immunodeficiency virus (HIV) infection. TB in HIV-positive patients may present atypically, both clinically and radiologically, with a lower probability of sputum positivity, greater difficulty in diagnosis, and a more rapid clinical deterioration than TB in HIV-seronegative patients. The emergence of multiple-drug-resistant strains of Mycobacterium tuberculosis , particularly in patients infected by HIV, carries a high mortality and has been associated with outbreaks in Europe and the USA. Microscopy and culture form the basis of diagnosis, but there is a need for more rapid diagnostic techniques and novel methods of drug susceptibility testing. Prolonged supervised treatment programmes and the development of new chemotherapeutic agents and regimens are essential prerequisites for successful TB therapy in AIDS patients. This review examines the clinical, microbiological and epidemiological issues associated with TB in HIV-infected individuals.