AIDSWEEKLY Plus, October 21, 1996
Salynn Boyles, Senior Editor

Researcher B.S. Ravi and colleagues from Brooklyn's New York Methodist Hospital also found that the majority of cases of TB among HIV infected individuals were the result of reactivation rather than recent transmission.

The findings were reported at the 36th meeting of the American Society for Microbiology's Interscience Conference on Antimicrobial Agents and Chemotherapy, held September 15-18, 1996 in New Orleans, Louisiana.

As part of the ongoing TBNetWork, a multicenter surveillance system monitoring transmission of tuberculosis throughout the New York City area, Ravi et al. collected data retrospectively for TB patients admitted to the Brooklyn secondary care community hospital between January 1994 to December 1994.

Out of 26 patients 17 were female, 11 were black, eight were white, six Hispanic, and one unknown. One-third of patients were in the age group between 46 to 49 years (26.9 percent); nine (34.6 percent) were foreign born, four had a history of treated TB, nine had positive PPD, and two had isoniazid prophylaxis for positive purified protein derivative.

Two were health professionals, 19 (73 percent) had pulmonary TB, three (11.5 percent) had lymph node involvement, one (3.8 percent) had synovial, two (7.69 percent) had spinal and one (3.8 percent) had peritoneal involvement.

Of the 18 patients with abnormal chest x-rays, only 11 were smear positive for acid-fast bacilli.

Only four (15 percent) were HIV positive, one of which showed a clonal (VI) strain pattern.

The mean duration of hospitalization before TB was suspected was 2.54 days, and drug resistance was seen in just four (15 percent) patients. One strain was resistant to isoniazid only; one to isoniazid and pyrazinamide, one to rifampin, one was grown from lymph node; three resistant strains were grown from sputum.

Using Double Repetitive Element - Polymerase Chain Reaction testing (DRE-PCR) only three clonal patterns were observed among the population; two among U.S. born and one from Puerto Rico. All V1 clones were drug susceptible; All clones were resistant to isoniazid.

"Contrary to popular belief, the percentage of HIV positive patients presenting with TB was low in our community and the clonal patterns suggested that reactivation rather than exogenous transmission was the main cause of TB in our community," Ravi et al. wrote. "Thus, by DNA fingerprinting we were able to identify resistant strains and thus aid in the choice of anti-TB medications and also in reducing the morbidity and hospital stay of these patients."

The corresponding author for this study is B.S. Ravi, New York Methodist Hospital, Brooklyn, New York.

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