TUBERCULOSIS AND AIDS

Since the mid-1980s, the rate of decline in reported cases of tubercul osis (TB) has reached a plateau or reversed because of a combination o f poverty and increased homelessness, immigration and displacement, po orly managed and supplied TB control programmes and, particularly in t he developing world, the emergence of human immuno-deficiency virus (H IV) infection. TB in HIV-positive patients may present atypically, bot h clinically and radiologically, with a lower probability of sputum po sitivity, greater difficulty in diagnosis, and a more rapid clinical d eterioration than TB in HIV-seronegative patients. The emergence of mu ltiple-drug-resistant strains of Mycobacterium tuberculosis, particula rly in patients infected by HIV, carries a high mortality and has been associated with outbreaks in Europe and the USA. Microscopy and cultu re form the basis of diagnosis, but there is a need for more rapid dia gnostic techniques and novel methods of drug susceptibility testing. P rolonged supervised treatment programmes and the development of new ch emotherapeutic agents and regimens are essential prerequisites for suc cessful TB therapy in AIDS patients. This review examines the clinical , microbiological and epidemiological issues associated with TB in HIV -infected individuals.