Controlling the emergence of tuberculosis (TB) in HIV-infected patients (Pt).
Int Conf AIDS 1994 Aug 7-12; 10:48 (abstract no. PS26) Gatell JM; Hospital Clinic, Barcelona, Spain.
Since mid 80's the incidence of TB is no longer declining, in western world. Moreover, outbreaks of multidrug resistant tuberculosis (MDRT) have been reported, mostly in USA, together with a mild increase in the baseline level of primary resistance to first line antituberculosis agents. There is a close temporal relationship between the HIV epidemic and the increasing incidence of TB. A percentage of the "unexpected" new cases of TB occur in already known HIV Pt. Apart from reactivation of latent forms, a substantial number of the cases of tuberculosis including MDRT in HIV patients may be relatively rapid progressions of recently acquired infections and also reinfections. Main step to control the emerging problem of TB including TB in HIV Pt and MDRT is early diagnosis, isolation measures while the sputum smear is positive (focusing in health care facilities), tracing contacts (houses, shelters, prisons), and starting soon the adequate treatment (even supervising it and making the necessary drugs available). On the other hand a PPD test should be performed in all HIV Pt. If positive chemoprophylaxis with Isoniazid is strongly recommended and has been proven effective, although the duration of the protection is yet to be determined. Chemoprophylaxis may also be considered in selected HIV Pt with skin anergy mainly when the CD4 cell count drops below a given threshold. It also remain to be tested if the recently recommended prophylaxis for MAC with Rifabutin will also cross protect for TB.
Keywords: AEGIS, Tuberculosis, Tuberculosis, Multidrug-Resistant, Antitubercular Agents, Tuberculin Test, Isoniazid, HIV Infections, Patient Isolation, Infection Control, Anti-HIV Agents, Tuberculin, Incidence, Human, prevention & control, ICA10 940807
PS26
