HIV-associated pulmonary tuberculosis.

The problems of diagnosis treatment and management of tuberculosis associated with HIV infection in Africa are placed in perspective by the former director of the Kenya Medical Research Institute. Tuberculosis (TB) has increased as much as 3-fold in many African countries due to heightened susceptibility of HIV patients. HIV infection may both re-activate latent TB which virtually all Africans harbor or increase the likelihood of exogenous infection or re-infection by TB. In most of Africa diagnosis by stained sputum smear is standard: in late AIDS this method may yield false negatives due to non-pulmonary TB or pulmonary TB with a negative smear. Chest x-rays are also atypical since cavitation of the upper zones is not as common but lobar consolidation and lower zone involvement and various unusual findings are likely. There is no evidence that mycobacterium avium intracellular has occurred in Africa. Treatment in Africa often centers on long-term thiazina (thiacetazone and isoniazid combined). HIV+ patients are more prone to skin rashes or even lethal epidermal neurolysis as a complication of treatment. Treated patients should be monitored for other symptoms such as diarrhea recurrent fevers other chest infections cerebral space occupying lesions urinary infections. Many can be treated with broad spectrum antibiotics such as chloramphenicol. Nursing HIV-infected young adults is an expensive and burdensome prospect for overworked and underpaid staff but curing TB in AIDS patients is possible and worthwhile because of the public health advantages.