Pulmonary Tuberculosis and Acquired Immunodeficiency Syndrome

Abstract

To the Editor:Dr. Syabbalo reemphasizes the importance of tuberculosis in patients with the acquired immunodeficiency syndrome (AIDS). In some parts of Africa, tuberculosis has been recognized to be associated frequently with human immunodeficiency virus (HIV) infection. In Kinshasa, Zaire, a seroprevalence of HIV infection of 33 percent (53 of 159) in patients with smear-positive pulmonary tuberculosis has been reported. 1Mann J Snider DE Jr; Francis H et al.Association between HTLV-III/LAV infection and tuberculosis in Zaire.JAMA. 1986; 256: 346Crossref PubMed Scopus (56) Google Scholar In Lusaka, Zambia, 24 percent (17 of 71) of tuberculosis patients were seropositive for HIV.2Melbye M Njelesani EK Bayley A et al.Evidence for heterosexual transmission and clinical manifestations of human immunodeficiency virus infection and related conditions in Lusaka, Zambia.Lancet. 1986; 2: 1113-1115Abstract PubMed Scopus (106) Google Scholar It is biologically and epidemiologically plausible to hypothesize that the tuberculosis incidence among AIDS patients is directly correlated to the prevalence of latent tuberculous infection in the population from which the AIDS cases emerge. This is also suggested by data from Florida on tuberculosis incidence among AIDS patients. While the crude incidence of tuberculosis among AIDS patients in Florida was 10 percent,3Centers for Disease ControlTuberculosis and acquired immunodeficiency syndrome—Florida.MMWR. 1986; 35: 587-590PubMed Google Scholar the proportion of AIDS patients who were identified in the tuberculosis record system varied from 2 percent among non-Hispanic whites to 29 percent among patients from Haiti (Table 1). These data strongly support recommendations that tuberculin skin testing is warranted in persons at risk or with HIV infection and that preventive therapy should be offered according to current guidelines.4Centers for Disease ControlDiagnosis and management of mycobacterial infection and disease in persons with human immunodeficiency virus infection.Ann Intern Med. 1987; 106: 254-256Crossref PubMed Scopus (100) Google ScholarTable 1Frequency of Tuberculosis in AIDS Patients in Florida, by Race, Country of Origin, and AgeAge group (yrs)White, non-Hispanic (percent)Black, US born (percent)Haitian (percent)Hispanic (percent)Other (percent)Total (percent)0-24321400012(1/36)*AIDS patients with tuberculosis/all AIDS patients.(4/19)(8/20)(0/5)(0/32)(13/112)25-44213297810(6/365)(22/165)(45/157)(7/105)(2/24)(82/816)45 +522151008(5/106)(5/23)(2/13)(2/21)(0/3)(14/166)Total215297310(12/507)(31/207)(55/190)(9/131)(2/59)(109/1, 094)* AIDS patients with tuberculosis/all AIDS patients. Open table in a new tab To the Editor: Dr. Syabbalo reemphasizes the importance of tuberculosis in patients with the acquired immunodeficiency syndrome (AIDS). In some parts of Africa, tuberculosis has been recognized to be associated frequently with human immunodeficiency virus (HIV) infection. In Kinshasa, Zaire, a seroprevalence of HIV infection of 33 percent (53 of 159) in patients with smear-positive pulmonary tuberculosis has been reported. 1Mann J Snider DE Jr; Francis H et al.Association between HTLV-III/LAV infection and tuberculosis in Zaire.JAMA. 1986; 256: 346Crossref PubMed Scopus (56) Google Scholar In Lusaka, Zambia, 24 percent (17 of 71) of tuberculosis patients were seropositive for HIV.2Melbye M Njelesani EK Bayley A et al.Evidence for heterosexual transmission and clinical manifestations of human immunodeficiency virus infection and related conditions in Lusaka, Zambia.Lancet. 1986; 2: 1113-1115Abstract PubMed Scopus (106) Google Scholar It is biologically and epidemiologically plausible to hypothesize that the tuberculosis incidence among AIDS patients is directly correlated to the prevalence of latent tuberculous infection in the population from which the AIDS cases emerge. This is also suggested by data from Florida on tuberculosis incidence among AIDS patients. While the crude incidence of tuberculosis among AIDS patients in Florida was 10 percent,3Centers for Disease ControlTuberculosis and acquired immunodeficiency syndrome—Florida.MMWR. 1986; 35: 587-590PubMed Google Scholar the proportion of AIDS patients who were identified in the tuberculosis record system varied from 2 percent among non-Hispanic whites to 29 percent among patients from Haiti (Table 1). These data strongly support recommendations that tuberculin skin testing is warranted in persons at risk or with HIV infection and that preventive therapy should be offered according to current guidelines.4Centers for Disease ControlDiagnosis and management of mycobacterial infection and disease in persons with human immunodeficiency virus infection.Ann Intern Med. 1987; 106: 254-256Crossref PubMed Scopus (100) Google Scholar