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Tuberculosis in Alaskan Native women with HIV disease: the first cases.
Macher A; Jones M; Webb V; Mann M; Palmer J; Goosby E; U.S. Public
December 30, 1994
Int Conf AIDS. 1994 Aug 7-12;10(2):173 (abstract no. PB0707). Unique

ISSUE: Through 30 June 1993, 69 Alaskan Natives had tested seropositive for HIV. Through 23 October 1993, 42 cases of tuberculosis (TB) were reported in Alaska; among these, 30 were Alaskan Natives. We report the clinical presentations and complications of the first Alaskan Natives to present with concomitant HIV disease and pulmonary TB. CASES: The first patient, with a CD4+ lymphocyte (CD4) count of 30/mm3, was admitted from a nursing home where she had a one month history of fever, cough and 12 pound weight loss. The second patient had been homeless, and presented with a CD4 count of 810/mm3 and a four month history of night sweats, cough and pleuritic chest pain. The clinical courses of these patients were complicated by a number of factors including abuse of cocaine and alcohol; an atypical roentgenographic pulmonary presentation; false negative PPD skin tests; false negative direct acid-fast smears; reliance upon a single negative acid-fast smear of concentrated sputum to rule out TB; patient non-compliance; et cetera. CONCLUSIONS: Historically, Alaska's native population has been disproportionately overrepresented by active cases of TB. As HIV infection surreptitiously spreads among the state's natives, additional patients will present with concomitant HIV disease and TB. Homelessness and polysubstance abuse will further complicate this multifactorial and multidimensional dilemma.

Alaska/EPIDEMIOLOGY AIDS-Related Opportunistic Infections/*DIAGNOSIS/EPIDEMIOLOGY Case Report CD4-Positive T-Lymphocytes False Negative Reactions Female Homeless Persons Human *Indians, North American Leukocyte Count Tuberculin Test Tuberculosis, Pulmonary/*DIAGNOSIS/EPIDEMIOLOGY ABSTRACT

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