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. 1992 Jun 1;146(11):1927–1934.

Spectrum of tuberculosis in patients with HIV infection in British Columbia: report of 40 cases.

M Korzeniewska-Kosela 1, J M FitzGerald 1, S Vedal 1, E A Allen 1, M T Schechter 1, L Lawson 1, P Phillips 1, W Black 1, J S Montaner 1
PMCID: PMC1490332  PMID: 1596841

Abstract

OBJECTIVE: To review the clinical features, treatment and outcome of all known cases of tuberculosis in patients with human immunodeficiency virus (HIV) infection in British Columbia between 1984 and 1990. DESIGN: Retrospective case review. SETTING: Provincial tuberculosis registry and university-affiliated HIV clinic. PATIENTS: All people with HIV infection in whom active tuberculosis was diagnosed during the study period. RESULTS: All 40 patients identified were men; their mean age was 38 years. Of the subjects 30 (75%) were homosexual, 6 (15%) were homosexual and used intravenous drugs, 2 (5%) just used intravenous drugs, and 1 (2%) had had heterosexual contact with prostitutes; for the remaining subject the risk factor for HIV infection was not established. In all cases cultures of specimens from 15 body sources yielded Mycobacterium tuberculosis. Thirty-five of the patients had acquired immunodeficiency syndrome (AIDS), and five had HIV infection uncomplicated except for tuberculosis. In 28 (70%) of the cases no AIDS-defining disease had previously been diagnosed, and in 23 (58%) extrapulmonary tuberculosis represented the AIDS-defining disease. Symptoms at presentation included weight loss (in 80% of the cases), fever (in 75%), cough (in 70%) and night sweats (in 55%). The mean CD4 lymphocyte count was 0.2 x 10(9)/L (in 15 cases). Tuberculin skin test results were positive in 8 of 16 cases. The most striking radiologic finding was intrathoracic adenopathy. All except one of the 36 patients who received appropriate treatment responded favourably at first. Adverse reactions necessitating changes in treatment occurred in 12 (33%) of the cases. Relapse occurred after completion of therapy in two cases (one at 3 weeks and the other at 9 months after treatment was stopped). Tuberculosis was the cause of death in five cases. CONCLUSIONS: Tuberculosis in people with HIV infection commonly presents as extrapulmonary disease and precedes or coincides with other AIDS-defining opportunistic infections. In most cases tuberculosis is the AIDS-defining disease. Even though radiologic findings are often unusual physicians should suspect tuberculosis. A careful examination for evidence of disease at multiple sites should be done. The duration and choice of therapy must be adequate to avoid relapse.

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Selected References

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  1. Bouza E., Martín-Scapa C., Bernaldo de Quirós J. C., Martínez-Hernández D., Menarguez J., Gómez-Rodrigo J., Cosín J., Sagues-Cifuentes M. J. High prevalence of tuberculosis in AIDS patients in Spain. Eur J Clin Microbiol Infect Dis. 1988 Dec;7(6):785–788. doi: 10.1007/BF01975050. [DOI] [PubMed] [Google Scholar]
  2. Braun M. M., Byers R. H., Heyward W. L., Ciesielski C. A., Bloch A. B., Berkelman R. L., Snider D. E. Acquired immunodeficiency syndrome and extrapulmonary tuberculosis in the United States. Arch Intern Med. 1990 Sep;150(9):1913–1916. [PubMed] [Google Scholar]
  3. Chaisson R. E., Schecter G. F., Theuer C. P., Rutherford G. W., Echenberg D. F., Hopewell P. C. Tuberculosis in patients with the acquired immunodeficiency syndrome. Clinical features, response to therapy, and survival. Am Rev Respir Dis. 1987 Sep;136(3):570–574. doi: 10.1164/ajrccm/136.3.570. [DOI] [PubMed] [Google Scholar]
  4. Di Perri G., Cruciani M., Danzi M. C., Luzzati R., De Checchi G., Malena M., Pizzighella S., Mazzi R., Solbiati M., Concia E. Nosocomial epidemic of active tuberculosis among HIV-infected patients. Lancet. 1989 Dec 23;2(8678-8679):1502–1504. [PubMed] [Google Scholar]
  5. FitzGerald J. M., Grzybowski S., Allen E. A. The impact of human immunodeficiency virus infection on tuberculosis and its control. Chest. 1991 Jul;100(1):191–200. doi: 10.1378/chest.100.1.191. [DOI] [PubMed] [Google Scholar]
  6. Fitzgerald J. M., Gafni A. A cost-effectiveness analysis of the routine use of isoniazid prophylaxis in patients with a positive Mantoux skin test. Am Rev Respir Dis. 1990 Oct;142(4):848–853. doi: 10.1164/ajrccm/142.4.848. [DOI] [PubMed] [Google Scholar]
  7. Jordan T. J., Lewit E. M., Montgomery R. L., Reichman L. B. Isoniazid as preventive therapy in HIV-infected intravenous drug abusers. A decision analysis. JAMA. 1991 Jun 12;265(22):2987–2991. [PubMed] [Google Scholar]
  8. Kramer F., Modilevsky T., Waliany A. R., Leedom J. M., Barnes P. F. Delayed diagnosis of tuberculosis in patients with human immunodeficiency virus infection. Am J Med. 1990 Oct;89(4):451–456. doi: 10.1016/0002-9343(90)90375-n. [DOI] [PubMed] [Google Scholar]
  9. Long R., Maycher B., Scalcini M., Manfreda J. The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodeficiency virus type 1. Chest. 1991 Jan;99(1):123–127. doi: 10.1378/chest.99.1.123. [DOI] [PubMed] [Google Scholar]
  10. Pitchenik A. E., Burr J., Suarez M., Fertel D., Gonzalez G., Moas C. Human T-cell lymphotropic virus-III (HTLV-III) seropositivity and related disease among 71 consecutive patients in whom tuberculosis was diagnosed. A prospective study. Am Rev Respir Dis. 1987 Apr;135(4):875–879. doi: 10.1164/arrd.1987.135.4.875. [DOI] [PubMed] [Google Scholar]
  11. Pitchenik A. E., Cole C., Russell B. W., Fischl M. A., Spira T. J., Snider D. E., Jr Tuberculosis, atypical mycobacteriosis, and the acquired immunodeficiency syndrome among Haitian and non-Haitian patients in south Florida. Ann Intern Med. 1984 Nov;101(5):641–645. doi: 10.7326/0003-4819-101-5-641. [DOI] [PubMed] [Google Scholar]
  12. Pitchenik A. E., Rubinson H. A. The radiographic appearance of tuberculosis in patients with the acquired immune deficiency syndrome (AIDS) and pre-AIDS. Am Rev Respir Dis. 1985 Mar;131(3):393–396. doi: 10.1164/arrd.1985.131.3.393. [DOI] [PubMed] [Google Scholar]
  13. Rieder H. L., Cauthen G. M., Bloch A. B., Cole C. H., Holtzman D., Snider D. E., Jr, Bigler W. J., Witte J. J. Tuberculosis and acquired immunodeficiency syndrome--Florida. Arch Intern Med. 1989 Jun;149(6):1268–1273. [PubMed] [Google Scholar]
  14. Rieder H. L., Cauthen G. M., Kelly G. D., Bloch A. B., Snider D. E., Jr Tuberculosis in the United States. JAMA. 1989 Jul 21;262(3):385–389. [PubMed] [Google Scholar]
  15. Schulzer M., Fitzgerald J. M., Enarson D. A., Grzybowski S. An estimate of the future size of the tuberculosis problem in sub-Saharan Africa resulting from HIV infection. Tuber Lung Dis. 1992 Feb;73(1):52–58. doi: 10.1016/0962-8479(92)90080-4. [DOI] [PubMed] [Google Scholar]
  16. Selwyn P. A., Hartel D., Lewis V. A., Schoenbaum E. E., Vermund S. H., Klein R. S., Walker A. T., Friedland G. H. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. N Engl J Med. 1989 Mar 2;320(9):545–550. doi: 10.1056/NEJM198903023200901. [DOI] [PubMed] [Google Scholar]
  17. Small P. M., Schecter G. F., Goodman P. C., Sande M. A., Chaisson R. E., Hopewell P. C. Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. N Engl J Med. 1991 Jan 31;324(5):289–294. doi: 10.1056/NEJM199101313240503. [DOI] [PubMed] [Google Scholar]
  18. Theuer C. P., Hopewell P. C., Elias D., Schecter G. F., Rutherford G. W., Chaisson R. E. Human immunodeficiency virus infection in tuberculosis patients. J Infect Dis. 1990 Jul;162(1):8–12. doi: 10.1093/infdis/162.1.8. [DOI] [PubMed] [Google Scholar]

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