TUBERCULOSIS AMONG PATIENTS WITH AIDS AND A CONTROL-GROUP IN AN INNER-CITY COMMUNITY

Background: Tuberculosis, the largest single cause of death of any inf ectious disease worldwide, has undergone a startling resurgence in the United States, partially related to the acquired immunodeficiency syn drome (AIDS) epidemic. Methods: To compare the clinical, roentgenograp hic, and bacteriologic characteristics of patients with AIDS and the g eneral population, we retrospectively analyzed the clinical records of all patients with tuberculosis in an inner-city population over a 4-y ear period. Forty-six patients with AIDS (including 38 injecting drug users [83%]) were identified and matched with a control group of 46 pa tients with tuberculosis who did not have AIDS. Results: Forty-one pat ients with AIDS (89%) had pulmonary tuberculosis; 10 (22%) had dissemi nated disease and 13 (28%) had concurrent extrapulmonary disease. Amon g the patients without AIDS, two (4%) had disseminated disease and fou r (9%) had extrapulmonary disease. Patients with AIDS were far more li kely to be black. Thirty-seven patients with AIDS (80%) had negative p urified protein derivative skin test results compared with eight contr ols (17%). Seventeen (41%) of 41 patients with AIDS presented with cla ssic post-primary upper-lobe disease compared with 32 (73%) of 44 pati ents in the control group. Primary tuberculosis features occurred pred ominately in the AIDS group. Four (10%) of 41 patients with AIDS prese nted with clear chest films despite positive smears and cultures. Nine patients with AIDS (20%) were drug-resistant compared with three cont rols (7%). Seven patients with AIDS with drug resistance were born in the United States (78%), while all controls with drug resistance were foreign-born. Conclusions: We found vast differences in the clinical, roentgenographic, and drug susceptibility characteristics of patients with tuberculosis who did and did not have AIDS.