Tuberculosis control and the AIDS epidemic in developing countries

The epidemic proportion of acquired immunodeficiency syndrome (AIDS) in developing countries is having an impact on the control of tuberculosis in those countries. Although tuberculous infection and tuberculosis are already common in some populations in such countries, the introduction and spread of AIDS compounds the problem because the rate of tuberculosis can increase markedly; moreover, human immunodeficiency virus (HIV) infection may be increasingly common in patients with tuberculosis. For example, the percentage of in- and outpatients with tuberculosis who had HIV in their blood (were seropositive) was 59 percent in Zambia, 58 percent in Uganda, 34 percent in Zimbabwe, and 16 percent in Nairobi. Of children with pulmonary tuberculosis in Zambia, 24 percent were found to be HIV-seropositive. In Florida, 75 to 91 percent of migrant workers had positive skin tests for tuberculosis; the prevalence of HIV seropositivity among Haitians with tuberculosis exceeded 45 percent. There are additional problems: in developing areas, tuberculosis control programs are stretched because of scarce resources, and drug-based tuberculosis prevention programs have a low priority in developing countries, yet this may be the most cost-effective way to approach the dual problem. There is an urgent need for studies to determine the most cost-effective way to control tuberculosis in the face of an already high or increasing rate of HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)