Tropical respiratory medicine. 2. Impact of human immunodeficiency virus on tuberculosis in developing countries.

Abstract

Mycobacterium tuberculosis is present in approximately 50% of 15-49 year olds in the developing world, while infection in Europe and North America is limited largely to the elderly and some disadvantaged groups. The authors concentrate upon the interaction of HIV infection and tuberculosis (TB) in developing countries with a particular focus upon research data from sub-Saharan Africa. They discuss HIV infection and predisposition for TB, epidemiological determinants of the TB-HIV interaction, HIV-2 and TB, the impact of HIV on TB treatment services, treatment regimes, and prevention. They note that HIV greatly increases a person's risk of contracting TB by reactivation or recent infection or both, and that HIV-associated TB is not more infectious. The efficacy of most diagnostic procedures is compromised by HIV and anti-TB drug resistance is associated with HIV infection in industrialized countries. TB responds well to optimal treatment, but death from other causes during treatment and recurrence of TB are common with the suboptimal regimens applied in most developing countries. Thiacetazone should be removed from treatment regimens because of its high incidence of toxicity. A need also exists to determine the duration of anti-TB treatment needed for HIV-infected patients. More effective drugs are needed, while short-course chemotherapy needs to be made available where it is currently in short supply or unavailable. The authors also recommend adherence to International Union against Tuberculosis and Lung Disease program guidelines.