The effects of the AIDS epidemic on the tuberculosis problem and tuberculosis programmes.

Abstract

The effects of the human immunodeficiency virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) epidemic on the tuberculosis problem are discussed. Data sources for this report include information contributed by the International Union Against Tuberculosis (IUAT) the Tuberculosis Surveillance Research Unit the US Centers for Disease Control the New York City Health Department and other national and international sources. According to recent estimates of the World Health Organization (WHO) and the IUATLD 8-10 million new cases of tuberculosis occur annually with approximately 3 million deaths. Some evidence for an increased risk of tuberculosis among persons coinfected with HIV comes from a study conducted by the New York City Health Department. The HIV antibody status of 519 intravenous drug users had been known from testing performed at a methadone clinic. 12 of 279 intravenous drug users who were HIV-infected developed tuberculosis as compared to 0/240 in the HIV noninfected group. Further evidence for an increased risk of tuberculosis for dually infected persons comes from the finding of high rates of HIV infection among tuberculosis patients in several countries. In addition to the possible effect of increasing the number of tuberculosis patients to which a program must provide service there are important qualitative changes for tuberculosis control in the HIV/AIDS area. New problems include concern about this new population of HIV coinfected persons and reports about possible altered safety or efficacy of the basic tuberculosis control practices. Further tuberculosis workers must deal with the challenge of additional concern for their own safety a concern for all health workers in HIV infected areas but tuberculosis workers in many locations will be caring for more HIV infected persons than most clinics. Needles are used in this setting for tuberculin skin testing and for streptomycin treatment injections and there are many HIV infected tuberculosis patients. The value of HIV testing in tuberculosis programs is unclear as yet. Research guidelines advocacy and support are indicated. The immediate needs are for improved surveillance and focused research to better define the magnitude of the problem and to determine future impact.