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M94A0218.TXT
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1994-10-08
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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).