The significance of bacteremic tuberculosis among persons with HIV infection in developing countries.

Disseminated mycobacterial infections have been recognized as important complications of HIV infection throughout the world. In developing countries mycobacteremia is principally caused by Mycobacterium tuberculosis (TB). Effective therapy for bacteremic TB in HIV infection would require clinical criteria or laboratory methods for expeditious diagnosis. Clearly new diagnostic and treatment strategies for disseminated TB need to be developed and studied. There is evidence of the feasibility of using the polymerase chain reaction for the rapid detection of Mycobacterium TB in blood indicating that this technology can be adapted for use in field settings. However data from preliminary studies are conflicting on the issue of whether previous mycobacterial infection is associated with protection from or risk of disseminated TB. In this context further research is urgently needed to define the pathophysiology of this infection to identify practical and cost-effective methods of diagnosis to assess the effects of early treatment on survival and to test the feasibility of prevention with either chemoprophylaxis or new vaccines for TB that are safe and immunogenic in HIV-infected persons.