Tuberculosis is the most common opportunistic infection among people infected with human immunodeficiency virus and its first cause of morbidity and mortality.To analyze the characteristics of a population in Israel with both tuberculosis disease and HIV infection in order to identify factors that contribute to outcome.The study group comprised patients hospitalized in the Pulmonary and Tuberculosis Department of Shmuel Harofeh Hospital during the period January 2000 to December 2006. They were located by a computer search of the hospital registry and the pertinent data were collected.During the study period 1059 cases of active tuberculosis disease were hospitalized; 93 of them were co-infected with HIV. Most of them came from endemic countries (61.2% from Ethiopia and 20.4% from the former Soviet Union; none of them was born in Israel). Ten percent of the cases were multiple-drug resistant and 32% showed extrapulmonary involvement. The response rate to the treatment was good, and the median hospitalization time was 70 days. The mortality rate was 3.2%.Despite the high prevalence of pulmonary disease in our group, the short-term outcome was good and the Mycobacterium was highly sensitive to first-line drugs. These encouraging results can be attributed to the fact that tuberculosis patients in Israel are identified early and treated continuously and strictly, with early initiation of antiretroviral therapy, which together ensure that the development of drug resistance is low.
20 patients with Crohn's disease were entered into a prospective study, after they had been submitted to standard treatment of the acute phase. In this study long term treatment or treatment between the acute relapses of the disease consisted in daily doses of 8 mg methylprednisolone and 3 mg salazosulfapyridine; in addition the diet was sugar-free and rich in fibers. When remission continued (activity index below 150 point) the drugs were stopped and only dietary treatment was continued. The course of the disease was followed by frequent endoscopic examinations and by determinations of the activity index according to Best. 16 patients were in remission after an average treatment period of 19.6+/-6.6 months without drugs only using the dietary regimen described. 4 cases relapsed after 7.5+/-4.3 months (activity index greater tha 150 points, intestinal ulcerations); they had to be treated again according to the acute phase standard treatment schedule. These results encourage further trials, where after 6 months of drug treatment the drugs are stopped, and only dietary treatment is continued during the remission phase.
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