HIV-INFECTION IN 567 ACTIVE PULMONARY TUBERCULOSIS PATIENTS IN BRAZIL

We studied 567 patients with active pulmonary tuberculosis (APT) in Ri o de Janeiro, Brazil, by using a standardized questionnaire and by tes ting blood for HIV antibodies. The rate of HIV infection was 3.9% in 1 987, 4.8% in 1988, and 5.2% in 1989, and did not differ by sex. It was highest (7.4%) in the 15- to 39-year age group. There was no differen ce between patients infected and not infected by HIV with regard to ed ucation, income, housing, or employment. Among all patients with defin ite HIV risk behavior, the HIV infection rate was 23.3%, rising to 31. 2% among homo/bisexual men and 36.4% among intravenous drug users, and the rate was 6.5% for blood-transfusion recipients. Among patients wh o denied risk behavior, the rate was 1.2%. Generalized lymphadenopathy and oral candidiasis occurred with greater frequency among HIV-infect ed patients (p < 0.0001). Applying the World Health Organization 1985 clinical criteria and revised case definition for AIDS, we found, resp ectively, sensitivities of 34% and 76.9% and specificities of 31% and 26.3%; in the Rio de Janeiro environment, these clinical criteria with out HIV serology should not be adopted for tuberculosis patients. For chest radiographs, a significant association was found between HIV inf ection and the occurrence of atypical images (p = 0.0001), and hilar a nd/or mediastinal adenopathy (p = 0.0002) and absence of cavities (p = 0.0003). A PPD (purified protein derivative) skin test induration of <5 mm was identified in 53% of the HIV-positive cases and in 31.3% of the HIV-negative cases. Only 11.5% of HIV-infected APT patients met th e Centers for Disease Control 1987 AIDS criteria.