Tuberculosis and human immunodeficiency virus infection in developing countries

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Estimates show that 5 million people worldwide are infected with human immunodeficiency virus (HIV). Recent estimates are that 8-10 million new tuberculosis (TB) cases occur each year in the world. 2-3 million die. In developing countries, TB is one of the most common opportunistic infections in people who are seropositive for HIV-1. About 90% of the TB is pulmonary. Of those without pulmonary tuberculosis, 85% had lymphadenopathy, bone and joint disease, or pleural effusion. In adults and children over 15 who had pulmonary TB, 78% had positive sputum smears for acid-fast bacilli. 66% had cavitation on chest radiography. Many people with TB and HIV infection have typical clinical and radiologic features. However, African clinicians have seen a change. This makes TB harder to diagnose. In Bangui, Central African Republic, 30% of pulmonary TB patients were HIV seropositive. Studies from Zaire and Zambia also had patients with suspected TB and extrapulmonary TB with higher HIV seropositivity rates than those with sputum-positive TB. Haitians show a similar disease pattern to that of Africa. 70% of people with tuberculosis and the acquired immunodeficiency syndrome (AIDS) had extrapulmonary disease compared with 20% of the HIV-negative people with TB. Chemotherapy of TB in Africans who also have HIV infection is not certain. Clinical impressions suggest that the disease responds well to the usual therapy. However, a Central African study found that mortality 12 months after the start of the usual drug therapy was 32.5% in HIV-seropositives compared with 1.5% in HIV-seronegatives. Several countries in Africa use short-course drug therapy for smear-positive pulmonary TB. They use the usual regime for smear-negative and extrapulmonary TB. Since AIDS, there are more skin allergic reactions to the usual drug therapy. There are more severe reactions now. Thiacetazone is the drug which probably causes this reaction. BCG immunization is used to control TB in Africa. World Health Organization guidelines are to withhold BCG from HIV- seropositive people with symptoms. What about infants born to HIV- seropositive mothers?