Tuberculosis among AIDS patients in the United States, 1993

Tuberculosis, injecting drug use and integrated HIV-TB care: a review of the literature

BACKGROUND

People who inject drugs (PWID) are at increased risk of tuberculosis (TB) and reduced retention in treatment. There is a need to document strategies for integrated delivery of HIV, TB and drug dependency care.

METHODS

This article reviews the literature on rates of TB mono- and co-infection, and published and grey literature descriptions of TB and HIV-TB care, among PWID.

RESULTS

Latent TB infection prevalence was high and active disease more common among HIV-positive PWID. Data on multidrug-resistant TB and co-infections among PWID were scarce. Models of TB care fell into six categories: screening and prevention within HIV-risk studies; prevention at TB clinics; screening and prevention within needle-and-syringe-exchange (NSP) and drug treatment programmes; pharmacy-based TB treatment; TB service-led care with harm reduction/drug treatment programmes; and TB treatment within drug treatment programmes. Co-location with NSP and opioid substitution therapy (OST), combined with incentives, consistently improved screening and prevention uptake. Small-scale combined TB treatment and OST achieved good adherence in diverse settings. Successful interventions involved collaboration across services; a client-centred approach; and provision of social care. No peer-reviewed studies described models of integrated HIV-TB care for PWID but grey literature highlighted key components: co-located services, provision of drug treatment, multidisciplinary staff training; and remaining barriers: staffing inefficiencies, inadequate funding, police interference, and limited OST availability.

CONCLUSIONS

Integration with drug treatment improves PWID engagement in TB services but there is a need to document approaches to HIV-TB care, improve surveillance of TB and co-infections among PWID, and advocate for improved OST availability.

Electron microscopic studies on bactericidal effects of electrolyzed acidic water on bacteria derived from kendo protective equipment

OBJECTIVES

Kendo protective equipment is used without washing for a long time.Staphylococcus saprophyticus, Micrococcus luteus, andBacillus sphaericus are frequently isolated from the mask ('men' in Japanese) of kendo protective equipment during one year. To investigate the bactericidal effects of electrolyzed acidic water on these three bacteria, we observed their cellular structures by electron microscopy after treatment with such water.

METHODS

Each bacterium isolated from 'men' was treated with electrolyzed acidic water and then observed under scanning and transmission electron microscopes.

RESULTS

WhenS. saprophyticus was treated with electrolyzed acidic water and its cellular structures were observed under a transmission electron microscope, ghost cytoplasm was observed, in which no ribosomal granules or fibrous DNA structures were present, and the cell wall inner layer was detached from the outer layer. Under a scanning electron microscope, the structure of the cell wall surface layer was wrinkled, and round pores were partially formed, indicating that the cytoplasmic structures were flushed out of the cells treated with electrolyzed acidic water through the pores formed in the cell wall. InM. luteus, the destruction of ribosomal granules and that of DNA fibers were observed to be similar to those ofS. saprophyticus. ForB. sphaericus, the effect of electrolyzed acidic water was investigated using vegetative cells. A dissociation between the cytoplasm and cell wall wrinkled the cell surface layer.

CONCLUSION

On the basis of above findings, electrolyzed acidic water was found to destroy the cellular structures of the three bacterial species frequently isolated from kendo men within a short time. Electrolyzed acidic water may be useful for disinfecting of kendo equipment.

Factors associated with tuberculosis as an AIDS-defining disease in an immigration setting

Background

Immigration can affect the evolution of TB as an AIDS-defining disease (AIDS–TB).

Methods

The Barcelona AIDS register for 1994–2005 was analyzed, and the global characteristics of AIDS–TB and AIDS–non-TB cases were compared. The Mantel-Haenszel test was used in the trend analysis, and logistic regression was used in the multivariate analysis.

Results

Of the 3600 cases studied, 1130 had both AIDS and TB. A declining trend in AIDS–TB rates was observed in both sexes among both immigrants and native residents. The percentage of AIDS–TB was significantly higher among immigrants (P = 0.02). The number of cases among immigrants remained constant over the period of study, but decreased among native residents. The sociodemographic and immunological characteristics associated with TB were male sex, age younger than 36 years, inner city residence, a record of incarceration, greater than 200 CD4+ T-cells/mm³, injecting drug use, heterosexual sex, and immigration from Latin America, the Caribbean, or sub-Saharan Africa.

Conclusions

The incidence of TB as an AIDS-defining disease decreased in Barcelona during a recent 10-year period in both native and immigrant populations. However, immigrants remain a high-risk group for AIDS–TB and should be targeted for surveillance and control of both diseases.

Comparison of AIDS progression and survival in persons with pulmonary versus extrapulmonary tuberculosis in Los Angeles

The objective of this research was to compare the demographics, acquired immune deficiency syndrome (AIDS) progression, and survival in persons with AIDS with pulmonary tuberculosis (PTB) versus extrapulmonary tuberculosis (EPTB), because there are limited population-based data on this topic. A population-based longitudinal study with 3 years of follow-up was performed. Data were collected every 6 months from medical records of persons with AIDS and TB treated at private and public medical facilities throughout Los Angeles County (LAC). Participants included a population-based sample of 216 persons with AIDS and PTB and 166 persons with AIDS and EPTB (including 113 persons with both PTB and EPTB), with an AIDS diagnosis reported in 1993. Compared to persons with AIDS with PTB, persons with AIDS and EPTB were 2.2 times more likely to be Latino than white (95% confidence intervals [CIs]: 1.2, 4.0) and 1.7 times more likely to be foreign-born (95% CIs: 1.1, 2.5). Compared to persons with AIDS with PTB, persons with AIDS and EPTB had similar antiretroviral and PCP prophylaxis use; lower CD4 counts at time of AIDS diagnosis (p = 0.0004); no differences in CD4 counts over the total follow-up period (p = 0.4); higher rates of total opportunistic infections (OIs) (incidence density ratio [IDR] = 2.0; 95% CIs: 1.6, 2.4); and comparable survival curves (p = 0.07). Persons with AIDS and EPTB had a more complicated medical course with lower CD4 counts at time of AIDS diagnosis and more OIs over the follow-up period than persons with AIDS and PTB, however the survival profiles for the two groups were comparable.

Cross-matching TB and AIDS registries: TB patients with HIV co-infection, United States, 1993-1994

OBJECTIVES

Because of limited reporting of HIV status in case reports to the national tuberculosis (TB) surveillance system, the authors conducted this study to estimate the proportion of US TB cases with HIV co-infection and to describe demographic and clinical characteristics of co-infected patients.

METHODS

The 50 states, New York City, and Puerto Rico submitted the results of cross-matches of TB registries and HIV-AIDS registries. The authors determined the number of TB cases reported for 1993-1994 that were listed in HIV-AIDS registries and analyzed data on demographic and clinical characteristics by match status.

RESULTS

Of 49,938 TB cases reported for 1993-1994, 6863 (14%) were listed in AIDS or HIV registries. The proportions of TB-AIDS cases among TB cases varied by reporting area, from 0% to 31%. Anti-TB drug resistance was higher among TB-AIDS cases, particularly resistance to isoniazid and rifampin (multidrug resistance) and rifampin alone, In some areas with low proportions of multidrug-resistant TB cases, however, the difference in multidrug resistance between TB-AIDS patients and non-AIDS TB patients was not found.

CONCLUSIONS

The proportion of TB cases with HIV co-infection, particularly in some areas, underscores the importance of the HIV-AIDS epidemic for the epidemiology of TB. Efforts to improve HIV testing as well as reporting of HIV status for TB patients should continue to ensure optimum management of coinfected patients, enhance surveillance activities, and promote judicious resource allocation and targeted prevention and control activities.

Pneumonia in the patient with HIV infection

The lower respiratory tract has always been a major site of complications in patients with human immunodeficiency virus (HIV) infection. In the era before Pneumocystis carinii prophylaxis (PCP) this organism accounted for more than 70% of initial AIDS-defining diagnoses and was by far the most common identifiable cause of mortality. Even in the era of prophylaxis, PCP continues to be the most common AIDS-defining diagnosis and the most common identifiable cause of death. Despite the historic emphasis on PCP, bacterial pneumonia seems to be at least as common or more common. A substantial spectrum of other opportunistic pathogens are also commonly encountered in these patients. This article reviews pneumonia in patients with HIV infection.