TUBERCULOSIS IN THOSE WITH HIV-INFECTION

Aims. To determine the incidence, demography, clinical features, treat ments and outcome for patients with tuberculosis and human immunodefic iency virus (HIV) infection in Auckland. Methods. We reviewed the note s of all patients with HIV infection and tuberculosis seen by the Infe ctious Disease Unit, at Auckland Hospital since the onset of the HIV e pidemic in New Zealand in 1984 until 31 December 1995. Results. Eleven patients have had HIV infection and tuberculosis, 2.4% of all those w ith HIV infection cared for by this unit, Ten were male and eight homo sexual, The median age was 30 years (range 24-57). The incidence in Pa keha was 1.2% (3 of 234), in Maori 20% (5 of 25) and in African 27% (3 of 11). Until 1990 we saw one case every two years and since then one or two cases per year, Six patients had normal chest x-rays and five had abnormal chest xrays; of the latter, three were typical of tubercu losis and two atypical, Ten of the eleven strains of Mycobacterium tub erculosis cultured were fully sensitive but one was resistant to both rifampicin and isoniazid. Conventional treatment regimens were used. S even patients have died of HIV infection, three continue treatment and one returned to Africa. One patient relapsed with fully sensitive tub erculosis. Three patients had major side effects to rifampicin necessi tating alternative treatment. Conclusions. Tuberculosis is uncommon am ongst those with HIV infection in Auckland but the incidence has risen in recent years. The risks amongst Maori and Africans are high. Multi drug resistant tuberculosis is uncommon. Those caring for patients wit h tuberculosis need to be mindful of HIV infection: those caring for p atients with HIV infection need to be increasingly alert for tuberculo sis.