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Query: UMLS:C0019693 (HIV)
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Between 1983 and 1989, we cared for 56 patients with tuberculosis and human immunodeficiency virus (HIV) infection. In 37 patients (66%), tuberculosis occurred before any other AIDS-defining disease (group 1); in 10 (18%) it occurred during the same month as another AIDS-defining disease (group 2); and in 9 (16%), after the diagnosis of AIDS (group 3). Tuberculosis was entirely pulmonary in 14 patients (25%), entirely extrapulmonary in 9 (16%), and both pulmonary and extrapulmonary in 33 (59%). The frequency of extrapulmonary involvement was similar in patients from group 1 and from groups 2 and 3 (combined): 76% versus 74%. Needle biopsy of the liver revealed hepatic involvement in 18 patients (32%). The mean CD4 lymphocyte count was 232/mm3 when tuberculosis was entirely pulmonary, and 243/mm3 when extrapulmonary disease was present (difference not significant). In group 1, the onset of both pulmonary and extrapulmonary tuberculosis occurred at the same stage of HIV infection, 12 and 10 months, respectively, before any other AIDS-defining disease. Treatment, planned to last 1 year, was highly effective, despite frequent side-effects. Among the 32 patients who completed treatment, relapse of tuberculosis occurred in 2 (6%) with a mean follow-up of 16 months (0-53 months) after completion. Our results suggest that pulmonary tuberculosis should be included in the criteria for diagnosis of AIDS.
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PMID:Should pulmonary tuberculosis be an AIDS-defining diagnosis in patients infected with HIV? 152 76

The impact of human immunodeficiency virus (HIV) on tuberculosis is well-documented. Its effect on populations with a high proportion of dually infected individuals is likely to be significant. Sub-Saharan Africa is one such region and in order to better document the effect of HIV infection on tuberculosis in that region, the authors developed a mathematical model to predict the likely extra numbers of tuberculosis due to it. A mathematical model was developed using a variety of scenarios which provided a range of risks for the 1980-2000 period. The 4 scenarios included: a low rate of 1% risk of tuberculosis infection in the year 0 (1980) with 45% tuberculosis infection prevalence and a HIV prevalence of 2% in 1989; a 2% risk of tuberculosis infection in year 0 with 60% tuberculosis infection prevalence and a 2% HIV prevalence in 1989; a 2% risk of tuberculosis infection in year 0 with 60% tuberculosis infection prevalence and a 10% HIV prevalence in 1989; and a 2% risk of tuberculosis infection in year 0 with 60% tuberculosis infection prevalence and a 20% HIV prevalence in 1989. In scenarios 1 and 2, a 50-60% increase in smear-positive rates in the subpopulation (ages 15-45 years old) is predicted for the year 2000; in scenario 3, smear-positive rates in the subpopulation in the year 2000 are expected to increase 4-fold from the 1980 baseline; and in scenario 4, a 10-fold increase in smear-positive rates in the year 200 is expected in the subpopulation. Total disease will have increased 12-fold in the subpopulation in this scenario. These data suggest that there will be a dramatic increase in the number of tuberculosis cases due to HIV infection in sub-Saharan Africa which will likely strain the already fragile health care system in this region. (author's modified)
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PMID:An estimate of the future size of the tuberculosis problem in sub-Saharan Africa resulting from HIV infection. 152 78

Highly sensitive up-to-date research methods (enzyme immunoassay) for HbsAg and antibodies against HBsAg and HBcAg were employed to examine 565 adults and children living in the Kalmuck++ ASSR (Elista and adjacent regions), where in 1988-1989 cases of HIV-infection were recorded. Markers of HBV-infection were detected with a high enough frequency in the control group of children (15.2%). The prevalence of the infection in the adult population was at an intermediate level (38.9%). The high infectivity with HBV-infection was recorded among children who had been hospitalized before (for different diseases including chronic ones), among women who had undergone laboratory studies because of the diagnosis of HIV-infection in their children; among adult patients suffering from tuberculosis of morons from a closed boarding school. The highest frequency of HBV-infection marker demonstration was found in HIV-infected children (70%). The data obtained point to the necessity of vaccination against viral hepatitis B in risk groups (children and adults) and in the newborn as well as of raising the efficacy of preventing measures against infections transmitted via blood.
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PMID:[Prevalence of hepatitis B in the focus of HIV infection]. 153 33

Between 1984-1991, physicians at Hospital del Mar in Barcelona, Spain and the area with the highest prevalence of tuberculosis (TB) diagnosed active pulmonary nondisseminated TB in 57 HIV infected patients. 3 of these patients consistently had normal chest radiographs. All 3 patients had fever and cough. Case 1 was a 26 year old female intravenous (IV) drug user. She had generalized lymphadenopathy. Hematologic tests revealed an HIV positive status. Her CD4+ lymphocyte count was 782 x 10 to the 6th power/1. Her tuberculin skin test was negative. Mycobacterium tuberculosis in her sputum grew in Lowenstein medium. Acid fast bacilli were detected in her sputum with Ziehl-Nielsen stain. Physicians began antiTB therapy (isoniazid, pyrazinamide, rifampin, and ethambutol). She improved within a few weeks. Case 2 was an HIV positive IV drug user and 33 years old. The CD4+ lymphocyte count was 645 x 10 to the 6th power/1. Acid fast bacilli were detected in his bronchoalveolar lavage with Ziehl-Nielsen stain. M. Tuberculosis in the lavage grew in Lowenstein medium. The physicians started him on the same antiTB therapy as Case 1. His condition improved with therapy. Case 3 was a 50 year old bisexual man. Hematologic tests showed HIV positivity. His CD4+ lymphocyte count was 790 x 10 to the 6th power/1. Further his tuberculin skin test was negative. Fibre optic bronchoscopic samples were negative for acid fast bacilli, but M. tuberculosis grew in Lowenstein culture. Blood, urine, bone marrow and gastric aspirates tested negative for M. tuberculosis. He began the same antiTB therapy as Cases 1 and 2. His condition improved. In conclusion, physicians should aggressively pursue a diagnosis to TB in HIV infected patients presenting with fever and cough. Their rate of hospitalization should fall with early diagnosis and treatment which will in turn prevent the spread of TB among the population.
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PMID:Pulmonary tuberculosis in HIV-infected patients with normal chest radiographs. 154 71

A retrospective analysis of all culture-positive cases of Mycobacterium tuberculosis infection in HIV positive individuals, over a 5 year period, revealed 18 cases, drawn from a population of approximately 1500. The prevalence of culture proven M. tuberculosis over the 5 year period was therefore 1.2% and was strongly associated with either a concomitant, or a subsequent, AIDS diagnosis. Sixty-one per cent had pulmonary tuberculosis, 17% had both extra-pulmonary and pulmonary infection and 22% had extra-pulmonary infection alone. Although a wide range of radiological abnormalities was seen, segmental consolidation was the commonest, occurring in 57% of cases. Only 55% of the specimens were positive on initial stains for M. tuberculosis, with a mean duration of 4 weeks to become culture positive, emphasizing that early diagnosis rests on clinical suspicion.
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PMID:Tuberculosis in HIV seropositive individuals--a retrospective analysis. 154 66

Mycobacterium gordonae is frequently isolated from urine, but M gordonae genitourinary disease is rare; the majority of the isolates are commensals. We describe a 40 year old housewife who presented with loin pain, dysuria and frequency. Urine contained excessive pus cells, was sterile on culture and she did not respond to broad spectrum antibiotics. There was repeated isolation of M gordonae from the urine and she responded to a standard antituberculosis regimen. She was irregular and non-compliant with supervised therapy and relapsed three months after stopping medications. She again had symptoms and M gordonae was repeatedly isolated from the urine, Mycobacterium tuberculosis and other pathogens were not isolated. There was no evidence of humoral or cellular immunodeficiency or HIV infection.
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PMID:Mycobacterium gordonae genitourinary disease. 154 12

Pulmonary tuberculosis still in on the list of the world major health problems. Tuberculosis has not been eradicated yet, from developing countries. Furthermore, its incidence is increasing in the industrialized world, due to the human immunodeficiency virus (HIV) epidemic. In this regard, atypical clinical presentation of tuberculosis in individuals who have a deficient immune system, such as those at risk of tuberculosis because of HIV infection, makes the diagnostic process more difficult. Tuberculosis cases are often diagnosed later in HIV individuals compared to non-HIV individuals. The ensuing greater risk of contagion thus requires rapid and sensitive diagnostic protocols. In this context, several biotechnological tools have been developed that can be applied to the diagnosis of tuberculosis. M. tuberculosis genes have been cloned, monoclonal antibodies against pure proteins have been produced, thus enabling researchers to generate molecular and biochemical probes. As a consequence, DNA hybridization and DNA amplification techniques have been applied to the detection of mycobacteria, and ELISA kits of high sensitivity are been already made available. In regard to the latter, it is likely that monospecific and highly sensitive immunoassays will be developed that are directed against "active disease" immunodominant antigens. It may thus be expected that future new technologies will supplement the traditional tools for the diagnosis of tuberculosis and rapid diagnosis protocols will be available to chest clinicians in a foreseeable future.
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PMID:[Mycobacterium tuberculosis. From the gene to the diagnosis]. 156 82

Tuberculosis should be prominently considered in the differential diagnosis when an HIV-infected patient has respiratory symptoms. Sputum smears and culture for acid-fast organisms should always be obtained. Fiberoptic bronchoscopy to exclude other concurrent opportunistic infections is appropriate because Pneumocystis carinii complicates as many as 25% of the cases of pulmonary TB, but acid-fast sputum smears should always be obtained. It should not be assumed that bronchoalveolar lavage is superior to expectorated sputum smear for the rapid diagnosis of pulmonary tuberculosis.
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PMID:Diagnosis of pulmonary tuberculosis complicating HIV infection: superiority of sputum smear over bronchoalveolar lavage. 156 55

The incidence of diseases among AIDS patients and controls was investigated through autopsies at the General Hospital of Mexico City. Of particular interest was the association between amebiasis and AIDS, and other parasitic diseases. AIDS cases and controls were selected from a registry of 600 autopsies/year which represents about 50% of all hospital-occurring deaths. 94 AIDS cases were obtained between August 1986-December 1989, which represents 85% of AIDS mortality cases. Case controls were matched by month of death, age, and gender in 2 periods, between 1972-79 before the 1st case of AIDS was diagnosed and between 1982-89. Analysis was conducted for each control group, but because results were almost identical, data were pooled and presented as 1 analysis. Conditional logistic regression models were used to estimate the odds ratios at a 95% confidence interval level. Of the AIDS autopsies, 55.4% were homosexual/bisexual men, 13.8% were infected through blood transfusions, 5.3% through heterosexual contact, and 24.9% in a no-risk category. Results indicate that there is no difference in the relative frequency or severity of amebiasis among AIDS compared with control cases. This finding is unrelated to the administration of antiamebic drugs to AIDS patients, since none were administered during the hospital stay. This finding is also supported by other studies including invasion by E. histolytica among HIV-infected patients in populations with a high incidence of chronic diarrhea. Another common parasitic disease, cysticercosis, was found also to be less frequent among AIDS patients compared with controls. Other infections found to greater than controls among AIDS patients were military tuberculosis, cytomegalovirus infection, pneumocystis carinii pneumonia, and cerebral toxoplasmosis.
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PMID:The prevalence of invasive amebiasis is not increased in patients with AIDS. 138 96

The impact of tuberculosis, the leading cause of death from a single infectious agent in the world, warrants a global control program. Every year, some 8 million people worldwide contract tuberculosis. Some 3 million die from it. It is estimated that 1/4 of all avoidable adult (15-59 years) deaths in the developing world each year are due to tuberculosis, meaning that the diseases represents one of greatest impediments to social and economic development. 2 recent developments have aggravated the tuberculosis problem: 1) the epidemic of HIV infection, which increases the risk that a tuberculosis infection will progress to disease; and 2) the appearance of strains that are resistent the major drugs used for the treatment of tuberculosis (isoniazid and rifampicin). Nonetheless, there currently exist effective tools for controlling tuberculosis, including the BCG vaccine and chemotherapy. Highly cost-effective, a well-managed chemotherapy treatment can cure almost any patient rapidly and render sputum-positive cases noninfectious, thereby reducing the transmission of the infection. Despite the existence of effective and cost-effective treatment methods, most countries have made little progress in combating the disease and the international community has given scant support. Given the magnitude of the problem, a global program for the control of tuberculosis is needed. Such a program should include advocacy, research, and capacity building, and should set as its target goal a 70% detection rate of all new cases and an 85% cure rate by the year 2000. Such a program would cost approximately $200 million a year, but would represent one of the most advantageous health investments possible.
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PMID:Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting. 156 78


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