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Tuberculosis and HIV infection.


 With the recent increase in tuberculosis (TB) cases, especially among AIDS patients, it has been projected that TB will be the leading cause of death in this population by the year 2000. It is vital that TB be considered by clinicians when diagnosing and treating HIV infection. Since HIV-infected people have immune systems that do not respond normally, criteria for TB positivity in HIV-infected people differ from those in immunocompetent people. False negative diagnoses are an area of concern since immunocompromised people develop anergy, that is, they are unable to mount an immune response. Treatment to prevent transition of TB infection into symptomatic TB disease includes multiple drugs and a treatment period of nine to eighteen months, depending on whether the TB is resistant to multiple drugs. Because the treatment regimen is difficult, clinicians must negotiate treatment plans with the patient and their family. In some cases, a health care worker must directly observe the patient taking medications, in others, incentives are given to comply with treatment. Proper precautions must also be taken to avoid transmission of TB to visitors and health care workers.
