Document 0218
 DOCN  M94A0218
 TI    [Association of tuberculosis and HIV infection (editorial)]
 DT    9412
 AU    Perronne C
 SO    Presse Med. 1994 Apr 23;23(16):731-3. Unique Identifier : AIDSLINE
       MED/94359862
 AB    Eight million people contract tuberculosis every year, 95% of them in
       developing countries, and one-third of the world's population is
       infected with Mycobacterium tuberculosis. Annually, tuberculosis causes
       three million deaths (in Africa 26% of the avoidable deaths). The main
       cause of dissemination is the absence of early diagnosis and
       insufficient treatment. Today, 3% of the new cases of tuberculosis are
       related to infection with the human immunodeficiency virus (HIV), a
       proportion which is rising rapidly. HIV infection does not change the
       classic rules of treatment; rifampicin, isoniazid, ethambutol and
       pyrazinamide for 2 months followed by at least 4 more months with a
       two-drug regimen (rifampicin and isoniazid). No-compliance is the major
       cause of recurrence, together with the risk of infection with another
       strain of M. tuberculosis. Certain authors suggest that in Africa, due
       to poor compliance and the lack of a sufficient provision of major
       antituberculous agents, treatment should be continued for life in HIV
       positive patients. Others propose chemotherapy for an HIV infected
       patients who are healthy carriers of M. tuberculosis. The risk of
       selecting mutant strains could be avoided by limiting prophylaxis to
       non-febrile patients. Nevertheless, the long-term effect of generalized
       chemoprophylaxis on the epidemiology of resistant strains is unknown.
       The only method of screening for healthy carriers is the tuberculin skin
       test but interpretation is complicated by prior BCG vaccination and now
       by HIV infection. There are two crucial steps required to control
       tuberculosis in this era of the tuberculosis-HIV partnership. First,
       patients should have easy and cost-free access to antituberculous drugs
       and second, compliance must be improved. Certain barriers have been
       lifted, including the requirement of patient identification to obtain
       free drugs. Hospital staffs must renew their efforts and attempt to
       follow-up their patients to assure compliance after discharge. All these
       measures will be difficult to implement but are the price we must pay to
       eradicate a new rise in the incidence of tuberculosis and the risk of
       multidrug-resistant strains. The only alternative may well be a return
       to pre-antibiotic days.
 DE    Acquired Immunodeficiency Syndrome/*COMPLICATIONS  Adult  Antibiotics,
       Combined/THERAPEUTIC USE  AIDS-Related Opportunistic Infections/DRUG
       THERAPY/EPIDEMIOLOGY/  *ETIOLOGY  Cross Infection  Drug Resistance,
       Microbial  English Abstract  Female  France/EPIDEMIOLOGY  Human
       Incidence  Male  Middle Age  Treatment Refusal  Tuberculosis,
       Pulmonary/DRUG THERAPY/EPIDEMIOLOGY/*ETIOLOGY/  PREVENTION & CONTROL
       EDITORIAL  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).