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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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 aim of the present study was to compare the clinical and radiographic presentation as well as the therapeutic outcome of pulmonary tuberculosis (PT) in adult patients with and without human immunodeficiency virus type 1 (HIV-1) infection in Kigali, Rwanda. Over a 17-month period, 59 consecutive patients with bacteriologically and/or histopathologically documented PT were enrolled. Of these, 48 (81%) patients were HIV seropositive. Among these, 35 fit the WHO clinical criteria for AIDS (WHOCCA) at the time of admission. Significant differences were found between the HIV-seropositive and HIV-seronegative groups of patients: fever (85 vs. 36%; p0.001), tuberculin skin test energy (69 vs. 0%; p0.01), mediastinal and/or hilar adenopathies (31 vs. 0%; p=0.05), and pleural effusion (43 vs. 9%; p0.05) were more frequently encountered in the HIV-seropositive group, and upper lobe infiltrates (55 vs. 16%; p0.02) and cavitation (91 vs. 39%; p0.003) were more often seen in the HIV-seronegative group. However, HIV-seropositive patients who did not meet WHOCCA were less frequently anergic (1 vs. 100%; p0.001) and feverish (53 vs. 97% p0.01) and more often had cavitation (69 vs. 28%; p0.02) and less often mediastinal and/or hilar adenopathies (7 vs. 40%; p0.04) compared with HIV seropositive patients who met WHOCCA. Under antituberculosis treatment, clearance of fever was slower in HIV-seropositive compared with HIV-seronegative patients, and among the HIV-seropositive group, it was slower in those who fit WHOCCA. Data collected from this study suggest that the clinical severity and the radiographic pattern of Hiv-associated PT are strongly related to the degree of progression of HIV infection. Although slower in advanced HIV infection, a favorable response to antituberculosis treatment was seen in all these groups of patients.
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PMID:Pulmonary tuberculosis in Kigali, Rwanda. Impact of human immunodeficiency virus infection on clinical and radiographic presentation. 162 14

From October 1987 to June 1988, we attempted to determine the prevalence of HIV infection among patients hospitalized with tuberculosis and the extent of immunosuppression among those tuberculosis patients infected with HIV. Of 178 consecutive patients, 18-65 years of age, who were hospitalized with newly diagnosed, previously untreated tuberculosis, 46% (82 out of 178) had clinical or serological evidence of HIV infection, 30% (54 out of 178) were HIV-seronegative, and 24% (42 out of 178) could not be assessed for the presence of HIV infection. Among the HIV-seropositive patients without an AIDS-defining diagnosis by non-tuberculous criteria, the median CD4 lymphocyte (CD4) count was 133 x 10(6) cells/l (range: 11-677 x 10(6]; among the HIV-seronegative patients, the median CD4 count was 613 x 10(6) cells/l (range: 238-1614 x 10(6); P less than 0.001). Among the HIV-seropositive patients, those with disseminated tuberculosis (median CD4 = 79 x 10(6) cells/l) and those with pulmonary tuberculosis who had radiographic evidence of mediastinal or hilar adenopathy (median CD4 = 45 x 10(6) cells/l) had the most severe CD4 depletion, whereas those with localized extrapulmonary tuberculosis (median CD4 = 242 x 10(6) cells/l) and those with pulmonary tuberculosis without adenopathy (median CD4 = 299 x 10(6) cells/l) were less severely immunosuppressed. Of the 178 patients, 6% (11 out of 178) were infected with strains of Mycobacterium tuberculosis resistant to both isoniazid and rifampin.
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PMID:HIV prevalence, immunosuppression, and drug resistance in patients with tuberculosis in an area endemic for AIDS. 167 82

The value of programmes to control pulmonary tuberculosis in developing countries remains the subject of debate. We have examined the cost-effectiveness of chemotherapy programmes for the control of pulmonary sputum-smear-positive tuberculosis in Malawi, Mozambique, and Tanzania. Effective cure rates of 86-90% were achieved with short-course chemotherapy and of 60-66% with standard chemotherapy. The average incremental costs per year of life saved were US $1.7-2.1 for short-course chemotherapy with hospital admission, $2.4-3.4 for standard chemotherapy with hospital admission, $0.9-1.1 for ambulatory short-course chemotherapy, and $0.9-1.3 for ambulatory standard chemotherapy. Chemotherapy for smear-positive tuberculosis is thus cheaper than other cost-effective health interventions such as immunisation against measles and oral rehydration therapy. Because the greatest benefit of chemotherapy is reduced transmission of the bacillus, treating HIV-seropositive, tuberculosis smear-positive patients would be only slightly less cost-effective than treating HIV-seronegative, tuberculosis-smear-positive patients.
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PMID:Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries. 168 93

A literature search of coinfection with HIV and leprosy retrieved 4 case reports, 4 epidemiologic studies, 2 primate studies, and an editorial The 1st case was a 43-year old male with borderline tuberculoid leprosy who was successfully treated with dapsone and clofazimine, but later developed Kaposi's sarcoma and pulmonary tuberculosis. The 2nd case was a 28-year old male from Martinique who had been treated with triple therapy (dapsone, rifampin, and clofazimine) for lepromatous disease with erythema nodosum leprosum for 9 years, but later developed reactive polyarthritis and 1+ bacterial index along with generalized lymphadenopathy with his HIV. A 3rd case was a 27-year old male who had been treated for cutaneous leprosy for 4 years. 5 years later he had polyneuropathy and palpable nerve trunks suggestive of a reversal reaction, and candida esophagitis with a CD4/CD8 ratio of 0.3. The 4th case was a 35-year old woman with BT-BB leprosy on clinical grounds, but apparent BL leprosy by histology. It was also noted that her granulomas had a high CD4+ lymphocyte count, while her circulating CD4/CD8 ratio was 0.6 with a low CD4 count of 300. The 4 epidemiologic series were from Zambia, Haiti, Ethiopia, and a large series of cases from Ivory Coast, Congo, Senegal, and Yemen. Some preliminary conclusions from these data were that HIV infection does not affect the clinical classification of leprosy, that HIV infection may confer anergy to lepromin, that HIV infection may cause relapse of leprosy, and that leprosy may accelerate the progression of HIV. There were 2 cases where leprosy grading reaction reversed or downgraded in coinfected patients. In the primate model, coinfection with SIV and M. leprae increases susceptibility of monkeys to leprosy.
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PMID:Leprosy and AIDS: a review of the literature and speculations on the impact of CD4+ lymphocyte depletion on immunity to Mycobacterium leprae. 168 45

Annually over the period 1985-90, 7.3 million new cases of tuberculosis and 2.7 million deaths are expected to develop in the developing world. Despite this high degree of morbidity and mortality, tuberculosis has been given insufficient attention over the past 2 decades. Research has, however, helped renew international interest in the disease. At the microlevel, studies have demonstrated the high cost-effectiveness of short-course chemotherapy in treating smear-positive pulmonary tuberculosis. This paper considers the costs and effectiveness of national tuberculosis programs in Malawi, Mozambique, and Tanzania, and finds short-course chemotherapy to be among the most cost-effective health interventions known. Such treatment is able to save 1 year of life at the cost of us $1-4. Short-course chemotherapy is more cost-effective than standard 12-month chemotherapy. The cost-effectiveness of hospitalization depends upon local patterns of compliance and the cost of hospitalization. In sum, it is probably cost-effective to treat HIV seropositive, smear-positive individuals.
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PMID:Social, economic and operational research on tuberculosis: recent studies and some priority questions. 168 7

The article proposes that the clinical case definition for Acquired Immunodeficiency Syndrome in Africa is an unworkable concept, with the wrong definition, incorrect validation, improper use, and consequently is a poor surveillance tool. The definition was proposed by the World Health Organization in 1986 to satisfy the use in countries with limited diagnostic resources, and resources for serological testing. Critical review until now of this procedure was lacking. Currently serological testing is available and of high quality. It does not seem justifiable to continue using a provisional surveillance definition. Abandoning this classification procedure may also lead to the focus on problems other than opportunistic infections and AIDs. Clinical surveillance is important, but as well morbidity and mortality need monitoring. It is argued that the definition is an unworkable concept because patients with underlying immunosuppression disorders such as AIDs can not be easily distinguished from chronic disease patients; i.e., pulmonary tuberculosis, renal failure, uncontrolled diabetes, or diarrhea with weight loss. Clinical accuracy is insufficient. It is the wrong definition because pulmonary tuberculosis with a persistent cough cannot be distinguished for those HIV positive and those not. There is inconsistency in the WHO clinical definition and the Centers for Disease Control definitions of AIDs. The incidence of tuberculosis in countries with unmodified clinical case definitions may contribute to an inflated number of AIDs cases. The wrong standards were used to validate the WHO definition in evaluative studies. The reference sensitivity ranges indicate that the definition is insensitive to identifying seropositive patients. Also, the HIV status of patients does not equate with AIDs. Although designed for surveillance, the clinical case definition is used by doctors for individual patient management. Labeling a patient as having AIDs, when he is HIV negative, leads to negative consequences. Researchers compare African AIDs data with North American data with imprecise and noncomparable definitions. As a surveillance tool in countries with a fragmentary or without a vital registration system, it is an inaccurate tool. Alternatives to obtaining data about the spread and impact of HIV are cluster sampling, hospital surveillance of selected populations, anonymous testing of pregnant women or patients in sexually transmitted disease clinics. In Nairobi, a necropsy survey found that 16% had AIDs but 38% were HIV positive.
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PMID:What use is a clinical case definition for AIDS in Africa? 173 1

7 men and 2 women seropositive for HIV were carefully screened for tuberculosis in the internal medicine service of a hospital in Sousse, central Tunisia, and all tuberculosis patients aged 20-50 years registered at the tuberculosis treatment center in Sousse between May 1987-December 1988 were screened for HIV infections using the ELISA test. The HIV seropositive patients ranged in age from 21-42 years and averaged 28 at the time of diagnosis. Marriage to an HIV-positive man was the only risk factor for the 2 seropositive women. 1 of the men had hemophilia and the rest had travelled abroad and used drugs or had homosexual or heterosexual relations while outside Tunisia. 4 of the 9 HIV positive patients were diagnoses with tuberculosis, 2 with isolated pulmonary tuberculosis, 1 with pulmonary and hepatoslenic tuberculosis, and 1 with a cervical ganglionary tuberculosis. 3 of the 4 with tuberculosis had apparently normal thoracic X-rays. The 4 were treated with the normal course of antitubercular drugs for a year or more. Screening for HIV in the 104 tuberculosis patients aged 20-50 years revealed no cases of HIV infection. Tuberculosis appears to be 1 of the most frequent opportunistic infections among patients seropositive for HIV, but it is not an indicator or predictor of HIV infection in central Tunisia as it reportedly is in some African countries.
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PMID:[AIDS and tuberculosis in central Tunisia]. 175 Jan 45

The chest radiographs and medical records of 166 patients diagnosed as having clinically active pulmonary tuberculosis were reviewed. Forty-nine patients (group I) were seropositives to human immunodeficiency virus (HIV), and 117 patients (group II) did not have known risk factors for HIV infection. Roentgenographic abnormalities were analysed in the two groups, according to nine different radiographic patterns previously defined. The seropositive group had a significantly higher proportion of hilar and/or mediastinal adenopathy (P less than 0.001), infiltrates confined to the lower lung fields (P less than 0.05), and miliary tuberculosis (P less than 0.005). Otherwise, single cavitation and destructive pattern were more frequent in the group II. These data suggest that patients with pulmonary tuberculosis and HIV infection are much more likely to have atypical radiographic findings.
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PMID:Radiographic findings in pulmonary tuberculosis: the influence of human immunodeficiency virus infection. 185 19

From December 19, 1990, through April 4, 1991, 12 cases of clinically active pulmonary tuberculosis (TB) were diagnosed at a residential facility for HIV-infected persons in San Francisco. This report summarizes results of the outbreak investigation.
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PMID:Tuberculosis outbreak among persons in a residential facility for HIV-infected persons--San Francisco. 189 Sep 84


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