HIV-ASSOCIATED TUBERCULOSIS IN AFRICA - THE EXAMPLE OF ZIMBABWE

In Africa, a rapid increase of human immunodeficiency virus (HIV)-asso ciated tuberculosis cases has been observed; 80% of a worldwide 6 mill ion dually infected persons live in this part of the world. The annual risk of progression to clinically overt tuberculosis in dually infect ed persons approaches the lifetime risk in persons with tuberculosis b ut no HIV infection. Zimbabwe is an example which illustrates the rapi d increase in notified tuberculosis cases since 1985, accounted for pr imarily by HIV-associated tuberculosis cases. In sputum-smear positive HIV-associated tuberculosis, classical symptoms are reported with the same frequency as in HIV negative cases. Thus, case-finding activitie s need not be altered. In sputum-smear negative patients, reliable dia gnostic tests are not available. Therapeutic trials are widely used an d this causes overdiagnosis of tuberculosis. Extrapulmonary manifestat ions are common in HIV-associated tuberculosis. A majority of lymphnod e enlargements, pleurisy and pericarditis in Africa are now due to tub erculosis. If compliance is ensured, response to chemotherapy is excel lent, but overall case fatality and relapse rates are increased. The c ost-effectiveness of tuberculosis control programmes using directly ob served therapy for at least the first 2 months of treatment is well es tablished. With the prominent global significance of tuberculosis and the possibility of cost-effective interventions, a commitment to the f ight against the worldwide epidemic is more important than ever before .