Tuberculosis In AIDS Patients Research Articles

Effect of Combined HAART Plus ATT in Patients of Extrapulmonary Tuberculosis in HIV Patients and Effect on Quality of Life.

HIV is a disease which reduces human resistant to fight. When our immunity becomes so weak that we are not able to fight even the common commensals of our body, this leads to what is called as an opportunistic infection. Tuberculosis is one of those most common type of opportunistic infection and in this pulmonary tuberculosis is more common. Extrapulmonary tuberculosis with HIV is the area of lesser research. In this study we tried to prove the Prevalence of extrapulmonary tuberculosis in AIDS patients and also the effect of combined HAART and ATT on prevalence of extrapulmonary tuberculosis and also its effect on Quality of life of the patient. This is a retrospective study conducted in a tertiary centre in the Department of Otorhinolaryngology & head and neck surgery from January 2020 to December 2020. A total of 80 patients were studied for 1year. Confirmed cases of AIDS with extra pulmonary tuberculosis in head and neck region were studied, keeping all ethical issues in mind and after complete treatment of ATT along with HAART. After treatment, a significant number of patients got resolved with EPTB and gave positive response on their quality of life. Not only pulmonary tuberculosis, extrapulmonary tuberculosis with HIV is on the rise nowadays. Combined treatment of both can help in decreasing prevalence of extrapulmonary tuberculosis and improves quality of life.

Xpert MTB/RIF Ultra in the auxiliary diagnosis of tuberculosis among people living with human immunodeficiency virus.

Clinical diagnosis of tuberculosis (TB) in people living with the human immunodeficiency virus (HIV) poses a challenge. The Xpert MTB/RIF Ultra (Ultra) has displayed greater sensitivity at diagnosing tuberculosis and rifampicin resistance compared to the Xpert MTB/RIF (Xpert). However, whether Ultra is able to facilitate an auxiliary diagnosis of TB in patients with an HIV-TB co-infection remains unclear. Accordingly, the current study evaluated the use of Ultra in patients with an HIV-TB co-infection by summarizing relevant studies. The sensitivity and specificity of Ultra and Xpert at diagnosing patients with an HIV-TB co-infection have been summarized and compared. The performance of Ultra in diagnosing extrapulmonary tuberculosis was also summarized. Although a large-cohort, multi-center study needs to be conducted to assess Ultra's ability to detect TB in AIDS patients in the future, the current evidence supports the use of Ultra for the assessment of patients with an HIV-TB co-infection.

Differential Diagnosis of Fungal Pneumonias vs. Tuberculosis in AIDS Patients by Using Two New Molecular Methods.

Opportunistic fungal pneumonias (OFP) are the main cause of death in AIDS patients worldwide. Diagnosis of these infections is often late as tuberculosis (TB) is frequently the first suspicion. In addition, diagnostic tools have limitations and are unavailable in disadvantaged regions. To perform the differential diagnosis of the main fungi causing OFP in AIDS patients (Histoplasma capsulatum, Cryptococcus neoformans/C. gattii and Pneumocystis jirovecii) vs. the Mycobacterium tuberculosis complex (MTBC), two new assays were developed: (i) a multiplex real-time PCR (MRT-PCR) and (ii) a simple and cost-effective method based on real-time PCR and the analysis of melting curves after amplification (MC-PCR). Both of the techniques were optimized and standardized “in vitro”, showing a suitable reproducibility (CV ranged between 1.84 and 3.81% and 1.41 and 4.83%, respectively), a 100% specificity and detection limits between 20 and 2 fg of genomic DNA per 20 µL of reaction. A validation study was performed by retrospectively using 42 clinical samples from 37 patients with proven fungal infection or TB, and 33 controls. The overall sensitivity for the MRT-PCR assay and the MC-PCR assay was 88% and 90.4%, respectively. Both techniques were fast, sensitive and reproducible, allowing for the detection of these pathogens and the performance of a differential diagnosis.

Emergence of antibiotic resistance in immunocompromised host populations: A case study of emerging antibiotic resistant tuberculosis in AIDS patients.

ObjectiveThe evolution of antibiotic resistance is far outpacing the development of new antibiotics, causing global public health concern about infections that will increasingly be unresponsive to antimicrobials. This risk of emerging antibiotic resistance may be meaningfully altered in highly AIDS-immunocompromised populations. Such populations fundamentally alter the bacterial evolutionary landscape in two ways, which we seek to model and analyze. First, widespread, population-level immunoincompetence creates a novel host environment with disrupted selective pressures. Second, within AIDS-prevalent populations, the recommendation that antibiotics be taken to treat and prevent opportunistic infection raises the risk of selection for drug-resistant pathogens.DesignTo determine the impact of HIV/AIDS on the emergence of antibiotic resistance–specifically in the developing world where high prevalence and economic challenges complicate disease management.MethodsWe present an SEIR epidemiological model of bacterial infection, and parametrize it to capture HIV/AIDS-attributable emergence of resistance under conditions of both high and low HIV/AIDS prevalence.ResultsWe demonstrate that HIV/AIDS-immunocompromised hosts can be responsible for a disproportionately greater contribution to emergence of resistance than would be expected based on population-wide HIV/AIDS prevalence alone.ConclusionsAs such, the AIDS-immunocompromised have the potential become wellsprings of novel, resistant, opportunistic pathogen strains that can propagate into the broader global community. We discuss how public health policies for HIV/AIDS management can shape the evolutionary environment for opportunistic bacterial infections.

Perbandingan Gambaran Foto Toraks Pasien TB-HIV Dua dan Enam Bulan Pengobatan Anti-Tuberkulosis + Anti-Retroviral

Background: Tuberculosis (TB) remains a global health issues and mostly located in developing countries. As cases of HIV/AIDS increase every year, it is estimated that TB cases also increase. TB is the leading cause of death in people with HIV and HIV infection, and became the biggest risk factor in the conversion of latent TB cases to become active TB. Radiographic manifestation of TB in AIDS patients depends on antiretroviral therapy (ART).Materials and Methods: This is an observational study which compares 2 and 6 months chest radiographs from TB-HIV patients with anti-TB drugs+ART in 24 adults patients with TB-HIV in the Internal Medicine Polyclinic and Ward at Dr. Kariadi Hospital and BKPM Semarang.Result: Most patients were male with 19 subjects (79.2%). The large stage group based on the proportion of AIDS cases is 20-29 years (45.84%). After 6 months of anti-TB drugs+ART there were radiographic improvement in consolidation, cavitation, lymphadenopathy and pleural e?usion. Wilcoxon Signed Ranks Test showed signifcant changes in consolidation and lymphadenopathy between 2 and 6 months of anti-TB drugs+ART, but no signifcant changes in cavity and pleural e?usion.Discussion: At 6 months chest radiographs examination, not all patients with anti-TB drugs+ART show radiographic improvement. Therefore, the decision to stop TB therapy in HIV patients in 6 months time seems inadequate.Conclusion: There are signifcant change between 2 and 6 months of anti-TB drugs+ART with radiographic improvement are consolidation and lymphadenopathy.

Computed tomography in predicting smear-negative pulmonary tuberculosis in AIDS patients

Background The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography (CT) and clinical findings in predicting smear-negative pulmonary tuberculosis in AIDS patients. Methods A total of 121 AIDS patients suspected of smear-negative pulmonary tuberculosis by clinical and radiographic findings were recruited. Pulmonary tuberculosis was diagnosed in 57 (47.1%) patients. The CT and clinical predictors were selected to diagnose AIDS-related pulmonary tuberculosis through univariate and multivariate Logistic analysis. Results Multivariate analysis showed that five variables, including weight loss, presence of miliary nodules, necrotic lymph node, lobular consolidation, tree-in-bud sign, were independent predictors of pulmonary tuberculosis in AIDS patients. Predicted scores based on the five variables were used to identify pulmonary tuberculosis. If the predicted score of 3 was taken as the ideal cut-off point in the diagnosis of AIDS-related smear-negative pulmonary tuberculosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 81.2%, 80.0%, 85.2%, and 82.6%, respectively. Conclusion The prediction method based on five key factors of clinical and CT findings are useful in guiding the diagnosis of smear-negative pulmonary tuberculosis in AIDS patients.

Abscesos tuberculosos hepáticos en pacientes con síndrome de inmunodeficiencia adquirida (SIDA).

We report a AIDS patient with the diagnosis of tuberculous liver abscess. We describe and compare our case with another seven patients reported in the medical literature since AIDS epidemic began. We reviewed the clinical presentations (usually fever and abdominal pain), the diagnositic tests (CT Scanguided needle aspiration or ultrasound) and the outcomes of the treatments. Also we did a review of the current literature available of the types of hepatic compromise related with Mycobacteriun tuberculosis in AIDS patients.

Evaluation of disease patterns, treatment and prognosis of tuberculosis in AIDS patient.

Patterns of disease, diagnosis, treatment and prognosis of tuberculosis in 100 patients co-infected with AIDS at Casa da AIDS clinic was studied. Demographic characteristics were as follows: 76 male patients, 24 female patients, 67 caucasian, average 35.8 years-old (SD +/- 8.5). Sexual transmission of HIV was reported in 68 patients. Pulmonary tuberculosis was seen in 40 patients, extrapulmonary in 11, and combined in 49 patients. In 63 patients, TCD(4)(+) counts were below 200/mm(3) when tuberculosis was diagnosed. Fifty-five patients had their diagnoses confirmed by bacteriological identification of Mycobacterium; either through direct observation and/or culture. Tuberculosis was treated with rifampin, isoniazid and pyrazinamide in 60 patients, reinforced treatment in 14 and alternative treatment in the other 13 patients. Tuberculosis therapy lasted up to 9 months in 66% of the patients. Fifty-four patients were treated with a two-drug antiretroviral regimen and the remaining 46 patients received a triple regimen, which included a protease inhibitor. Among the latter, 35 patients were co-treated with rifampin. The occurrence of hepatic liver enzyme abnormalities was statistically related to alternative antiretroviral regimens (p = 0.01) and to the co-administration of rifampin and protease inhibitor (p = 0.019). Clinical resolution of tuberculosis was obtained in 74 patients. Twelve patients died during tuberculosis treatment. Resolution of tuberculosis was statistically significant related to antituberculosis treatment adherence (p = 0.001). The risk of no response to the treatment was 1.84 times more frequent among patients treated with alternative regimens regardless of the duration of the therapy. We conclude that the characteristics of tuberculosis in HIV infected patients requires that special attention be directed to the types and duration of both antiretroviral and anti-TB therapy in order to achieve the highest level of care.

Polymerase chain reaction in the diagnosis of tuberculosis.

A rapid, sensitive, specific and yet economical method for the diagnosis ofM. tuberculosis and other mycobacteria in clinical specimen is a desperate and urgent requirement of the day in the laboratory diagnosis and hence management of tuberculosis. This need is further accentuated by emerging diseases like multi drug resistant tuberculosis, tuberculosis in AIDS patients and opportunistic mycobacterial infections, which do not respond to conventional anti TB therapy. Molecular methods, particularly PCR based detection ofM. tuberculosis, has come a long way since it was first described about fifteen years ago. Several probes have been developed and some of them, particularly the IS6110 and TB400 have been validated on several clinical samples. The latter has been validated on a variety of clinical specimens along with a simple sample processing method. Polymerase chain reaction based diagnosis ofM. tuberculosis has been introduced as one of the routine/confirmatory tests in clinical microbiology laboratory in some countries like Canada, the United States and the United Kingdom several years ago. The possibility of introducing PCR based direct diagnosis of drug resistance is being explored in some laboratories, particularly for drugs like rifampicin. The evolution and application of PCR for diagnosis ofM. tuberculosis is being analysed and discussed in this review.

Tuberculose extrapulmonar em pacientes com AIDS na cidade do Rio Grande, Brasil. Diagnóstico laboratorial

Foram analisadas 102 amostras clínicas de sítios extrapulmonares refereotes a 74 pacieotes com AIDS, entre Setembro de 1997 e Dezembro de 1999, do Serviço de AIDS do Hospital Universitário da Universidade Federal de Rio Grande, na cidade de Rio Grande, RS, Brasil. Este estudo teve como objetivo enfatizar a importância do diagnóstico laboratorial da tuberculose extrapulmonar nos padentes com AIDS e com suspelta clínica dessa enfermidade. Foi realizada baciloscopla a partir de esfregaços corados pela técnica de Kinyoun e cultivo primário para isolamento em melo de Ogawa e Ogawa acresido de ácido p-nitrobenzóico, de ácido tiofeno-2-carboxílico e de piruvato de sódio. Foi feita a determinação da produção de niacina para confirmação do isolamento de Mycobacterium tuberculosis . O diagnóstico de tuberculose extrapulmonar foi obtido em 12,74% das amostras provenientes de 17% dos pacientes. A distribuição das amostras com resultados positivos quanto ao sítio de obtenção, inclui: 8/13 blópsias ganglionares, 2/13 biópsias hepáticas, 2/13 líquido ascítico e 1/13 líquido pelural. A baciloscopla foi positiva em 7/13 amostras e a cultura em 10/13. Em 3/13 casos a baciloscopia foi a única responsável pelo diagnóstico de tuberculose extrapulmonar e a cultura em 6/13. Das amostras positivas à baciloscopia 6/7 eram biópsias ganglionares e 1/7, líquido ascítico. Os dois métodos utilizados na busca do diagnóstico da forma extrapulmonar de tuberculose, mostraram um rendimento que nos leva a incentivar cada vez mais a realização sistemática dos mesmos em nosso meio. REV PORT PNEUMOL 2000; VI (4): 277-282 One hundred two specimens of extrapulmonary material from 74 AIDS patients from the AIDS Service of University Hospital, FURG, Rio Grande, RS, Brazil, were examined at Mycobacteria Laboratory, between September 1997 and December 1999. This study had the aim to evaluate laboratoy importance in the diagnosis of extrapulmonary tuberculosis in AIDS patients with clinical suggestive symptoms of tuberculosis. Acid-fast bacilli (AFB) stains were performed using the Kinyon Method (cold stainning). Mycobacterial isolation was made In the Ogawa medium. The Ogawa medium added with p-nitrobenzoic acid, 2-tiophenocarboxylic acid hidrazide and pyruvic acid sodium salt was used to the Identification of mycobacterial species. Confirmation of Mycobacterium tuberculosis was done by the niacin test. The extrapulmonary tuberculosis diagnosis was done in 12,74% of specimens from 17,56% of the patients. Distribution of specimens with positive results in relation to the obtained sites were: 8/13 lymph node biopsies, 2/13 liver biopsies, 2/13 ascitic nuid and 1/13 pleural nuid. ABF were found on microscopic examination from 7/13 specimens and 10/13 in culture. The microscopic examination of ABF stain was the only method responsible for the extrapulmonary tuberculosis diagnostic in 3/13 cases and the culture in 6/13 cases. Among the positive specimens at microscopic examination or ABF stains, 6/7 were lymph node biopsies and In ascitic fluid. The used methods in the diagnosis, of the extrapulmonary tuberculosis showed good results, by this way we strongly recommend the realization of both as routine in our place. REV PORT PNEUMOL 2000; VI (4): 277-282

Pulmonary tuberculosis in AIDS patients: transient chest radiographic worsening after initiation of antiretroviral therapy.

Immune function and inflammatory responses often increase in AIDS patients who receive antiretroviral therapy. We evaluated the occurrence and nature of transient worsening on chest radiographs in AIDS patients with tuberculosis after initiation of antiretroviral therapy and compared these findings with chest radiographs of patients undergoing antituberculous therapy alone. A retrospective review of sequential chest radiographs was performed of 87 patients undergoing therapy for pulmonary tuberculosis: AIDS patients receiving antiretroviral therapy (n = 31), HIV-positive patients not receiving antiretroviral therapy (n = 26), and HIV-negative patients (n = 30). Pulmonary consolidations, thoracic lymphadenopathy, and pleural effusions were evaluated for worsening, stability, or improvement. Patients with concurrent pulmonary infections were excluded. Transient worsening on radiography was observed in 14 (45%) of 31 AIDS patients receiving antiretroviral therapy, including seven patients (23%) who showed severe worsening. Of 56 patients in the other two groups, 11 (20%) showed worsening (p = 0.023), two of whom showed severe worsening (p = 0.009). Worsening was first noted between 1 and 5 weeks after initiation of antiretroviral therapy, with improvement occurring between 2 weeks and 3 months later. Four patients with severe worsening converted their tuberculin purified protein derivative responses from anergic to positive after antiretroviral treatment. Transient worsening is frequently seen on chest radiography in AIDS patients with tuberculosis who subsequently undergo antiretroviral therapy. This phenomenon may be related to improved immune function.

Paracoccidioidomycosis and tuberculosis in AIDS patients: Report of two cases in Brazil

AIDS is spreading rapidly in Brazil. Caused by the dimorphic fungus Paracoccidioides brasiliensis paracoccidioidomycosis (PBM) is one of the systemic mycoses most frequently diagnosed among immunocompetent individuals in Latin America. The condition is most commonly diagnosed among agricultural workers living in humid tropical and subtropical rural regions. According to Marques et al. the estimated incidence of PBM among Brazilian AIDS patients in 1992 was 0.09% and among the 26 reported cases there was a 29.4% mortality rate. Given the current increase in the heterosexual transmission of HIV and the simultaneous spread of HIV to more rural areas of Latin America there will probably be an increase in the number of people infected concurrently with HIV and P. brasiliensis who present with PBM as the first manifestation of AIDS. 2 cases are described in which PBM was found together with tuberculosis as the first manifestation of AIDS. Both patients were living in urban areas of Brazil at the time of diagnosis. One case was a 48 year old male painter complaining of persistent fever without chills for 1 month a rapidly growing cervical mass and a 7 kg weight loss over 45 days. The second case was a 28 year old man admitted for the evaluation and treatment of a draining cervical lymph node and skin lesions. He related that his disease began 5 months earlier presenting with fever and cervical lymphadenopathy.

Tuberculous Pleurisy Is More Common in AIDS Than in Non-AIDS Patients With Tuberculosis

To investigate the incidence, clinical features, and treatment of tuberculous pleurisy in AIDS patients. We reviewed all cases of pleural tuberculosis in AIDS patients in South Carolina from 1988 through 1994. Clinical findings, test results, treatment, and outcome were analyzed. Twenty-two (11%) of the 202 AIDS patients with tuberculosis had pleural involvement compared to 6% (169/2,817) pleural involvement in non-AIDS patients (p=0.01). Associated features of AIDS tuberculous pleurisy included substantial weight loss (7.65+/-1.35 kg) and lower lobe infiltrates (12/22; 55%). No difference in pleural fluid characteristics was found when comparing AIDS patients with a serum CD4 count > or =200/microL to patients with CD4 count <200/microL. Two (9%) of the 22 patients died of tuberculosis. Chest radiograph follow-up of 20 patients showed complete resolution in 7, improvement in 10, and no improvement in 3. In South Carolina, pleural involvement is more common in AIDS patients than in non-AIDS patients with tuberculosis. Tuberculous pleurisy has several atypical features in AIDS patients such as substantial weight loss and lower lobe infiltrates. The outcome of treatment is good for most patients.

AIDS-associated renal tuberculosis.

In order to study the prevalence and the clinical features of renal tuberculosis associated with AIDS, we studied the renal tissue of the necropsies made in 46 AIDS patients under light microscopy. We found renal tuberculous granuloma in 11 (23%) patients (in 3 without previous diagnosis of renal or extrarenal tuberculosis) and only 4 of them presented moderate hematuria or pyuria sterile. As subclinical renal tuberculosis was frequent in this group of AIDS patients, the urine culture for Mycobacterium tuberculosis may be useful for diagnosing tuberculosis in AIDS patients.

177-PA12 Some aspects of pulmonary tuberculosis in AIDS patients

177-PA12 Some aspects of pulmonary tuberculosis in AIDS patients

Pulmonary Tuberculosis in Sputum-Negative Brazilian AIDS Patients

Physicians reviewed charts of 96 AIDS patients who had respiratory difficulties and who had undergone fiberoptic bronchoscopy at the Federal University Hospital in Rio de Janeiro Brazil between December 1988-February 1990. They did this to identify simple readily available clinical and laboratory predictors of pulmonary tuberculosis (TB) in AIDS patients whose sputum tested negative for TB. 13 patients had a history of previous TB but none of these experienced active pulmonary disease. Physicians diagnoses TB in 18 AIDS patients (18.75%). They depended on bacilloscopy and/or culture of bronchoalveolar lavage material to diagnose BY in 17 patients and on histopathologic findings in a biopsy fragment to do so in the other patient. If fiberoptic bronchoscopy had not been available the physicians would not have been able to diagnose TB in these patients. The clinical researchers found the significant and independent predictors of TB to include peripheral blood leukocytosis left shift in neutrophil count considerable weight loss no accompanying diagnosis of another opportunistic infection and no previous diagnosis of TB. These predictors have the potential to be used as criteria to diagnose TB in AIDS patients in developing countries where sophisticated diagnostic techniques are either not available or available in only a few hospitals. They could help health practitioners determine the need to refer AIDS patients with possible TB to tertiary health centers. In conclusion prospective studies on identifying predictors of TB in AIDS patients are needed to verify these predictors.

Use of the SL-IV and the PGL-Tbl Glycolipid Antigens in ELISA for the Diagnosis of Tuberculosis in AIDS Patients

At a predetermined specificity of 100.0%, the sensitivity of ELISA using the PGL-Tb1 and SL-IV antigens and IgG assays was 35.0% for the diagnosis of tuberculosis in AIDS patients (44.1% when tuberculosis was diagnosed before AIDS, 21.7% when AIDS was diagnosed before tuberculosis). Serial assays in sera collected from 11 AIDS patients before tuberculosis was diagnosed indicated that significant antibody titres were detected 10 months before the onset of clinical tuberculosis. Consequently, it was proposed that serodiagnosis using the glycolipid specific antigens should help in deciding on preventive antituberculosis treatment in these patients.

High prevalence of tuberculosis in AIDS patients in Spain.

A total of 67 cases of tuberculosis was diagnosed in the first 100 cases of AIDS, diagnosed according to the former CDC criteria, at a hospital in Madrid, Spain. This is the highest known prevalence of tuberculosis in AIDS patients both within and outside Spain. The clinical manifestations of tuberculosis were very variable and atypical. The rate of isolation of Mycobacterium tuberculosis from blood was particularly high: of 25 patients in whom blood cultures were performed, 16 were positive. In a third of the patients with proven mycobacteremia, blood was the first or the only positive specimen. In general, therapy resulted in rapid clinical improvement, but in some cases mycobacteria were isolated from clinical or necroscopy specimens months after what was considered adequate therapy.

AIDS in Africa—clinicopathological aspects

Clinical aspects of AIDS in Africa differ remarkably from those seen in the West: knowledge of the pathological basis of the clinical syndromes would be advantageous since African hospitals usually lack facilities for diagnostic testing. Pneumocystis carinii pneumonia is relatively rare in Africa while tuberculosis is not only common in the general population but routinely treated in AIDS patients. The etiology of the outstanding feature of AIDS in Africa slim disease accompanied by non-bloody diarrhea has not been characterized. Patients have higher incidence of Cryptosporidium and Isospora belli parasites than HIV- negative diarrhea patients but neither Enterocytozoa Mycobacteria Strongyloides Entamoeba nor cytomegalovirus are responsible for the diarrhea. Neuropsychiatric manifestations of AIDS are reported to occur but the incidence is not known. M. avium-intracellulare is very rare in Africa even though the organism is common there. M. tuberculosis in AIDS patients takes on a different course with lymphadenopathy widely disseminated distribution and anergic necrotic lesions without upper lung cavitation. People do respond to chemotherapy but the infection resumes after therapy ends. Since hospital impatient care is dominated by AIDS cost-effective ways of diagnosing and treating concurrent infections would greatly improve management.

Mycobacterial infections and AIDS.

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.