Impact of Human Immunodeficiency Virus Infection on the Epidemiology, Clinical Features, Management, and Control of Tuberculosis

Abstract

After years of decreasing prevalence and increasing hope that tuberculosis, like smallpox, could be eliminated, the disease has resurfaced as a major public health problem in the United States. Particularly ominous are the appearance of multiple-drug-resistant strains and their impact on patients and health care workers who are infected with the human immunodeficiency virus, among whom mortality rates reach 80% 2–3 months postdiagnosis. To respond effectively to this new threat, it is critical that we reorient our thinking about tuberculosis and redirect health care resources to programs for tuberculosis control. We need to reinstitute screening of high-risk populations and ensure proper isolation of patients with the disease. Diagnosing tuberculosis at the earliest possible stage is obviously of the utmost importance. High priority must be given to the development of rapid diagnostic tests and techniques that screen for drug resistance. We must implement and adequately fund drug-discovery programs to develop new therapeutic agents that are effective against multiple-drug-resistant strains of Mycobacterium tuberculosis. Effective programs for monitoring the treatment of patients with tuberculosis must also be implemented. Failure to adequately support such programs has probably led to the recent upswing in multiple-drug-resistant tuberculosis, especially in large cities along the eastern seaboard. Leadership for and funding of these programs must come from the federal government, specifically the U.S. Department of Health & Human Services and the Centers for Disease Control (Atlanta). The Infectious Diseases Society of America is actively supporting a variety of tuberculosis control-related initiatives and will keep its members updated on progress in this area. We plan to publish a series of commentaries focusing on tuberculosis during the coming year. We invited Dr. Philip C. Hopewell to initiate this series with an AIDS Commentary that provides an overview of the critical interaction between infection with human immunodeficiency virus and tuberculosis. Dr. Hopewell is a professor of medicine at the University of California, San Francisco, and head of the Division of Pulmonary and Critical Care Medicine at San Francisco General Hospital.