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Tuberculosis and AIDS: Epidemiologic, Clinical, and Social Dimensions

Published online by Cambridge University Press:  01 January 2021

Peter A. Selwyn
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In little more than a decade, the AIDS epidemic has exerted a profound effect on morbidity and mortality among young adults and children in many parts of the world. One of the more dramatic aspects of AIDS is that it seems to have arisen almost spontaneously as a new epidemic, spreading rapidly within at-risk populations in a way that is unprecedented for the serious infectious diseases of recent memory. Tuberculosis, on the other hand, had only recently been considered a disease of historical importance but of diminishing relevance to current public health priorities, especially in industrialized countries. Over the past decade, however, and in parallel with the AIDS epidemic, there has been a resurgence of tuberculosis in many of the same populations most affected by HIV infection. This has had important implications for clinical practice, public health, and the development of appropriate health policy. A number of elements have converged to promote the development of HIV-related tuberculosis, including biologic, social, and environmental factors. These will be discussed both to provide a context for understanding the relationship between the two epidemics, and as a basis for suggesting strategies for tuberculosis control in the AIDS era.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 21 , Issue 3-4 , Fall Winter 1993 , pp. 279 - 288
Copyright
Copyright © American Society of Law, Medicine and Ethics 1993

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References

Styblo, K., “Overview and Epidemiologic Assessment of the Current Global Tuberculosis Situation with an Emphasis on Control in Developing Countries,” Rev Infect Dis, 11 (1989): S339–S346; Pitchenik, A.E., “Tuberculosis Control and the AIDS Epidemic in Developing Countries,” Ann Intern Med, 113 (1990): 89-90; Styblo, K., “The Global Aspects of Tuberculosis and HIV Infection,” Bulletin of the International Union Against Tuberculosis and Lung Disease, 65 (1990): 28-32.CrossRefGoogle Scholar
Comstock, A.W., O'Brien, R.J., “Tuberculosis” in Evans, A.S. and Brachman, P.S., Bacterial Infections of Humans: Epidemiology and Control (New York: Plenum Publishing Corporation, (1991): 745–771.CrossRefGoogle Scholar
Rieder, H.L., Snider, D.E., “Tuberculosis and the Acquired Immunodeficiency Syndrome,” Chest, 90 (1986): 469–470.CrossRefGoogle Scholar
Centers for Disease Control, “National Action Plan to Combat Multidrug-resistant Tuberculosis,” MMWR, 41 No. RR-11 (1992): 1–48; Hopewell, P.C., “Impact of Human Immunodeficiency Virus Infection on the Epidemiology Clinical Features, Management, and Control of Tuberculosis,” Clin Infect Dis, 15 (1992): 540-547; Barnes, P.F., Block, A.B., Davidson, P.T. et al., “Tuberculosis in Patients with Human Immunodeficiency Virus Infection,” N Engl J Med, 324 (1991): 1644-1650; Selwyn, P.A., Hartel, D., Lewis, V.A. et al., “A Prospective Study of the Risk of Tuberculosis Among Intravenous Drug users with HIV Infection,” N Engl J Med, 320 (1989): 545-550; Selwyn, P.A., Sckell, B., Alcabes, P. et al., “High Risk of Active Tuberculosis in HIV-infected Drug Users with Cutaneous Anergy,” JAMA, 268 (1992): 504-509.Google Scholar
Centers for Disease Control, “National Action Plan to Combat Multidrug-resistant Tuberculosis,” MMWR, 41 No. RR-11 (1992): 1–48.Google Scholar
Pitchenik, A.E., “Tuberculosis Control and the AIDS Epidemic in Developing Countries,” Ann Intern Med, 113 (1990): 89–90; Harries, A.D., “Tuberculosis and Human Immunodeficiency Virus Infection in Developing Countries,” Lancet, 335 (1990): 387-390; “Africa's Tuberculosis Burden and Chemoprophylaxis [editorial],” Lancet, 335 (1990): 1249-1250; DeCock, K.M., Soro, B., Lucas, S.B. et al., “Tuberculosis and HIV Infection in Sub-Saharan Africa,” JAMA, 268 (1992): 1581-1587.CrossRefGoogle Scholar
DeCock, K.M., Soro, B., Lucas, S.B. et al., “Tuberculosis and HIV Infection in Sub-Saharan Africa,” JAMA, 268 (1992): 1581–1587.CrossRefGoogle Scholar
Centers for Disease Control, “Tuberculosis-United States, 1985-and the Possible Impact of Human T-lymphotropic Virus Type III/lymphadenopathy-Associated Virus Infection,” MMWR, 35 (1986): 74–76; Centers for Disease Control, “Tuberculosis and HIV Infection: Recommendations of the Advisory Committee for the Elimination of Tuberculosis (ACET),” MMWR, 38 (1989): 236-250; New York City Department of Health, “Tuberculosis in New York City: 1988 Information Summary,” New York City Department of Health, (1990); Centers for Disease Control, “Tuberculosis and Acquired Immunodeficiency Syndrome — New York City,” MMWR, 36 (1987): 785-795; Jereb, J.A., Kelly, G.D., Dooley, S.W., Couthen, G.M., Snider, D.E., “Tuberculosis Morbidity in the United States: Final Data, 1990,” MMWR, 40 (No. SS-3) (1991): 23-26.Google Scholar
New York City Department of Health, “Tuberculosis in New York City: 1988 Information Summary,” New York City Department of Health, (1990); Selwyn, P.A., “Tuberculosis in the AIDS Era: A New Threat from an Old Disease,” New York State Journal of Medicine, 91 (1991): 233-235; Rieder, H.L., Cauthen, G.M., Kelly, G.D. et al., “Tuberculosis in the United States,” JAMA, 262 (1989): 385–389.Google Scholar
Rieder, H.L., Cauthen, G.M., Kelly, G.D. et al., “Tuberculosis in the United States,” JAMA, 262 (1989): 385–389.CrossRefGoogle Scholar
Onorato, I.M., McCray, E., “Prevalence of Human Immunodeficiency Virus Infection Among Patients Attending Tuberculosis Clinics in the United States,” J Infect Dis, 165 (1992): 87–92.CrossRefGoogle Scholar
Selwyn, P.A., “Tuberculosis in the AIDS Era: A New Threat from an Old Disease,” New York State Journal of Medicine, 91 (1991): 233–235; Brudney, K., Dobkin, J., “Resurgent Tuberculosis in New York City,” Am Rev Respir Dis, 144 (1991): 745-749; New York City Department of Health, “Tuberculosis, New York City: The 1990 Experience,” City Health Info, 10 (1991): 1-5.Google Scholar
Rieder, H.L., Cauthen, G.M., Kelly, G.D. et al., “Tuberculosis in the United States,” JAMA, 262 (1989): 385–389.CrossRefGoogle Scholar
Centers for Disease Control, “National Action Plan to Combat Multidrug-resistant Tuberculosis,” MMWR, 41 No. RR-11 (1992): 1–48; Chaisson, R.E., Slutkin, G., “Tuberculosis and Human Immunodeficiency Virus Infection,” J Infect Dis, 159 (1989): 96-100; Centers for Disease Control, “Projections of the Number of Persons Diagnosed with AIDS and the Number of Immunosuppressed HIV-infected—United States, 1992–1994,” MMWR, 41 (RR-18) (1992); Centers for Disease Control, “HIV Prevalence Estimates and AIDS Case Projections for the United States: Report Based upon a Workshop,” MMWR, 39 (1990): 1-31.Google Scholar
Selwyn, P.A., Hartel, D., Lewis, V.A. et al., “A Prospective Study of the Risk of Tuberculosis Among Intravenous Drug users with HIV Infection,” N Engl J Med, 320 (1989): 545–550; New York City Department of Health, “Tuberculosis, New York City: The 1990 Experience,” City Health Info, 10 (1991): 1-5; Novick, L.F., Berns, D., Stricof, R. et al., “HIV Seroprevalence in Newborns in New York State,” JAMA, 261 (1989): 1745-1750; Novick, LF, “New York State HIV Seroprevalence Project,” Am J Public Health, 81(S) (1991): 9-63.CrossRefGoogle Scholar
DiPerri, G., Cruciani, M., Danzi, M.C. et al., “Nosocomial Epidemic of Active Tuberculosis Among HIV-infected Patients,” Lancet, 2 (1989): 1502–1504; Daley, C.L., Small, P.M., Schecter, G.F. et al., An Outbreak of Tuberculosis With Accelerated Progression Among Persons Infected with the Human Immunodeficiency Virus: An Analysis Using Restriction-Fragment-Length Polymorphisms,” N Engl J Med, 26 (1992): 231-235; Fischl, M.A., Uttamchandani, R.B., Daikos, G.L. et al., “An Outbreak of Tuberculosis Caused by Multiple-Drug-Resistant Tubercle Bacilli Among Patients with HIV Infection,” Ann Intern Med, 117 (1992): 177-183; Pearson, M.L., Jereb, J.A., Frieden, T.R. et al., “Nosocomial Transmission of Multidrug-Resistant Mycobacterium Tuberculosis,” Ann Intern Med, 117 (1992): 191-196; Beck-Sague, C., Dooley, S.W., Hutton, M.D. et al., “Hospital Outbreak of Multidrug-Resistant Mycobacterium Tuberculosis Infections,” JAMA, 268 (1992): 1280-1286; Centers for Disease Control, “Transmission of Multidrug-Resistant Tuberculosis Among Immunocompromised Persons in a Correctional System – New York, 1991,” MMWR, 41 (1992): 507-509; Centers for Disease Control, “Nosocomial Transmission of Multidrug-Resistant Tuberculosis Among HIV-infected Persons – Florida and New York, 1988–199,” MMWR, 40 (1991): 585-591; Edlin, B.R., Dooley, S.W., “An Outbreak of Multidrug-Resistant Tuberculosis Among Hospitalized Patients with the Acquired Immunodeficiency Syndrome,” N Engl J Med, 326 (1992): 1514-1521.Google Scholar
Daley, C.L., Small, P.M., Schecter, G.F. et al., “An Outbreak of Tuberculosis with Accelerated Progression Among Persons Infected with the Human Immunodeficiency Virus: An Analysis Using Restriction-Fragment-Length Polymorphisms,” N Engl J Med, 26 (1992): 231–235; Pearson, M.L., Jereb, J.A., Frieden, T.R. et al., “Nosocomial Transmission of Multidrug-Resistant Mycobacterium Tuberculosis,” Ann Intern Med, 117 (1992: 191-196.CrossRefGoogle Scholar
Hopewell, P.C., “Impact of Human Immunodeficiency Virus Infection on the Epidemiology Clinical Features, Management, and Control of Tuberculosis,” Clin Infect Dis, 15 (1992): 540–547; Barnes, P.F., Block, A.B., Davidson, P.T. et al., “Tuberculosis in Patients with Human Immunodeficiency Virus Infection,” N Engl J Med, 324 (1991): 1644-1650; Chaisson, R.E., Slutkin, G., “Tuberculosis and Human Immunodeficiency Virus Infection,” J Infect Dis, 159 (1989): 96-100.CrossRefGoogle Scholar
DeCock, K.M., Soro, B., Lucas, S.B. et al., “Tuberculosis and HIV Infection in Sub-Saharan Africa,” JAMA, 268 (1992): 1581–1587; Shafer, R.W., Chirgwin, K.D., Glatt, A.E. et al., “HIV Prevalence, Immunosuppression, and Drug Resistance in Patients with Tuberculosis in an Area Endemic for AIDS,” AIDS, 5 (1991): 399-405; Theuer, C.P., Hopewell, P.C., Elias, D. et al., “Human Immunodeficiency Virus Infection in Tuberculosis Patients,” J Infect Dis, 162 (1990): 8-12.CrossRefGoogle Scholar
DeCock, K.M., Soro, B., Lucas, S.B. et al., “Tuberculosis and HIV Infection in Sub-Saharan Africa,” JAMA, 268 (1992): 1581–1587; Shafer, R.W., Chirgwin, K.D., Glatt, A.E. et al., “HIV Prevalence, Immunosuppression, and Drug Resistance in Patients with Tuberculosis in an Area Endemic for AIDS,” AIDS, 5 (1991): 399-405; Theuer, C.P., Hopewell, P.C., Elias, D. et al., “Human Immunodeficiency Virus Infection in Tuberculosis Patients,” J Infect Dis, 162 (1990): 8-12.CrossRefGoogle Scholar
Centers for Disease Control and Prevention, “1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults,” MMWR, 41 (No. RR-17) (1992): 1–19.Google Scholar
Centers for Disease Control, “A Strategic Plan for the Elimination of Tuberculosis in the United States,” MMWR, 38 (Suppl. S-3) (1989): 1–25; Centers for Disease Control, “Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Settings, with Special Focus on HIV-Related Issues,” MMWR, 39 (RR-17) (1990): 1-29; American Thoracic Society, CDC, “Control of Tuberculosis in the United States,” Am Rev Respir Dis, 146 (1992): 1623-1633.Google Scholar
Comstock, A.W., O'Brien, R.J., “Tuberculosis” in Evans, A.S. and Brachman, P.S., Bacterial Infections of Humans: Epidemiology and Control (New York: Plenum Publishing Corporation, 1991): 745–771; Selwyn, P.A., Sckell, B., Alcabes, P. et al., “High Risk of Active Tuberculosis in HIV-infected Drug Users with Cutaneous Anergy,” JAMA, 268 (1992): 504-509; American Thoracic Society, CDC, “Control of Tuberculosis in the United States,” Am Rev Respir Dis, 146 (1992): 1623-1633; Centers for Disease Control, “Screening for Tuberculosis and Tuberculous Infection in High-Risk Populations; and the Use of Preventive Therapy for Tuberculous Infection in the United States: Recommendations of the Advisory Committee for Elimination of Tuberculosis,” MMWR, 39 (RR-8) (1990): 1-12; Wadhawan, D., Hira, S., Mwansa, N. et al., “Isoniazid Prophylaxis among Patients with HIV-1 infection,” VI International Conference on AIDS, San Francisco, June (1990): (abstract Th.B.510).CrossRefGoogle Scholar
Selwyn, P.A., Sckell, B., Alcabes, P. et al., “High Risk of Active Tuberculosis in HIV-infected Drug Users with Cutaneous Anergy,” JAMA, 268 (1992): 504–509; Centers for Disease Control, “Tuberculin Reactions in Apparently Healthy HIV-Seropositive and HIV-Seronegative Women—Uganda,” MMWR, 39 (1990): 638-646; Centers for Disease Control, “Purified Protein Derivative (PPD)-Tuberculin Anergy and HIV Infection: Guidelines for Anergy Testing and Management of Anergic Persons at Risk of Tuberculosis,” MMWR, 40 (1991): 27-33.CrossRefGoogle Scholar
Centers for Disease Control, “Purified Protein Derivative (PPD)-Tuberculin Anergy and HIV Infection: Guidelines for Anergy Testing and Management of Anergic Persons at Risk of Tuberculosis,” MMWR, 40 (1991): 27–33.Google Scholar
Selwyn, P.A., Sckell, B., Alcabes, P. et al., “High Risk of Active Tuberculosis in HIV-infected Drug Users with Cutaneous Anergy,” JAMA, 268 (1992): 504–509.CrossRefGoogle Scholar
Centers for Disease Control, “Purified Protein Derivative (PPD)-Tuberculin Anergy and HIV Infection: Guidelines for Anergy Testing and Management of Anergic Persons at Risk of Tuberculosis,” MMWR, 40 (1991): 27–33.Google Scholar
Centers for Disease Control, “National Action Plan to Combat Multidrug-Resistant Tuberculosis,” MMWR, 41 No. RR-11 (1992): 1–48; Dooley, S.W., Jarvis, W.R., Martone, W.J. et al., “Multidrug-resistant tuberculosis,” Ann Intern Med, 117 (1992): 257-259; Frieden, T.R., Sterling, T., Pablos-Mendez, A. et al., “The Emergence of Drug-Resistant Tuberculosis in New York City,” N Engl J Med, 328 (1993): 521-526.Google Scholar
Goble, M., Iseman, M.D., Madsen, L.A. et al., “Treatment of 171 Patients with Pulmonary Tuberculosis Resistant to Isoniazid and Rifampin,” N Engl J Med, 328 (1993): 527–532.CrossRefGoogle Scholar
Centers for Disease Control, “Transmission of Multidrug-Resistant Tuberculosis among Immunocompromised Persons in a Correctional System—New York, 1991,” MMWR, 41 (1992): 507–509; Centers for Disease Control, “Nosocomial Transmission of Multidrug-Resistant Tuberculosis among HIV-infected Persons—Florida and New York, 1988–1991,” MMWR, 40 (1991): 585-591; Centers for Disease Control, “Tuberculosis Outbreak among Persons in a Residential Facility for HIV-infected Persons—San Francisco,” MMWR, 40 (1991): 649-652.Google Scholar
Braun, M.M., Truman, B.I., Maguire, B. et al., “Increasing Incidence of Tuberculosis in a Prison Inmate Population: Association with HIV Infection,” JAMA, 261 (1989): 393–397; Bellin, E.Y., Fletcher, D.D., Safyer, S.M., “Association of Tuberculosis Infection with Increased Time in or Admission to the New York City Jail System,” JAMA, 269 (1993): 2228-2231.CrossRefGoogle Scholar
Centers for Disease Control, “Transmission of Multidrug-Resistant Tuberculosis among Immunocompromised Persons in a Correctional System—New York, 1991,” MMWR, 41 (1992): 507–509.Google Scholar
DiPerri, G., Cruciani, M., Danzi, M.C. et al., “Nosocomial Epidemic of Active Tuberculosis among HIV-infected Patients,” Lancet, 2 (1989): 1502–1504; Daley, C.L., Small, P.M., Schecter, G.F. et al., “An Outbreak of Tuberculosis with Accelerated Progression among Persons Infected with the Human Immunodeficiency Virus: An Analysis Using Restriction-Fragment-Length Polymorphisms,” N Engl J Med, 26 (1992): 231-235; Fischl, M.A., Uttamchandani, R.B., Daikos, G.L. et al., “An Outbreak of Tuberculosis Caused by Multiple-Drug-Resistant Tubercle Bacilli among Patients with HIV Infection,” Ann Intern Med, 117 (1992): 177-183; Pearson, M.L., Jereb, J.A., Frieden, T.R. et al., “Nosocomial Transmission of Multidrug-Resistant Mycobacterium Tuberculosis,” Ann Intern Med, 117 (1992): 191-196; Beck-Sague, C., Dooley, S.W., Hutton, M.D. et al., “Hospital Outbreak of Multidrug-Resistant Mycobacterium Tuberculosis Infections,” JAMA, 268 (1992): 1280-1286; Centers for Disease Control, “Nosocomial Transmission of Multidrug-Resistant Tuberculosis among HIV-infected Persons—Florida and New York, 1988–1991,” MMWR, 40 (1991): 585-591; Edlin, B.R., Dooley, S.W., “An Outbreak of Multidrug-Resistant Tuberculosis among Hospitalized Patients with the Acquired Immunodeficiency Syndrome,” N Engl J Med, 326 (1992): 1514-1521.Google Scholar
Centers for Disease Control, “Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Settings, with Special Focus on HIV-Related issues,” MMWR, 39 (RR-17) (1990): 1–29; Centers for Disease Control, “Mycobacterium Tuberculosis Transmission in a Health Clinic—Florida, 1988,” MMWR, 38 (1989): 256-264.Google Scholar
Torres, R.A., Mani, S., Altholz, J. et al., “Human Immunodeficiency Virus Infection among Homeless Men in a New York City Shelter. Association with Mycobacterium Tuberculosis Infection,” Arch Intern Med, 150 (1990): 2030–2036; McAdam, J.M., Brickner, P.W., Scharer, L.L. et al., “The Spectrum of Tuberculosis in a New York City Men's Shelter Clinic (1982–1988),” Chest, 97 (1990): 798-805; Slutkin, G., “Management of Tuberculosis in Urban Homeless Indigents,” Public Health Reports, 101 (1986): 481-485.CrossRefGoogle Scholar
Reichman, L.B., Felton, C.P., Edsall, J.R., “Drug Dependence a Possible New Risk Factor for Tuberculosis Disease,” Arch Intern Med, 139 (1979): 337–339.CrossRefGoogle Scholar
Reichman, L.B., “The U-Shaped Curve of Concern,” Am Rev Respir Dis, 144 (1991): 741–742.CrossRefGoogle Scholar
Centers for Disease Control, “Tuberculosis and Acquired Immunodeficiency Syndrome—New York City,” MMWR, 36 (1987): 785–795; Rieder, H.L., Cauthen, G.M., Kelly, G.D. et al., “Tuberculosis in the United States,” JAMA, 262 (1989): 385-389.Google Scholar
Small, P.M., Schecter, G.F., Goodman, P.C. et al., “Treatment of Tuberculosis in Patients with Advanced Human Immunodeficiency Virus Infection,” N Engl J Med, 324 (1991): 289–294.CrossRefGoogle Scholar
Barnes, P.F., Block, A.B., Davidson, P.T. et al., “Tuberculosis in Patients with Human Immunodeficiency Virus Infection,” N Engl J Med, 324 (1991): 1644–1650; Small, P.M., Schecter, G.F., Goodman, P.C. et al., “Treatment of Tuberculosis in Patients with Advanced Human Immunodeficiency Virus Infection,” N Engl J Med, 324 (1991): 289-294.CrossRefGoogle Scholar
Centers for Disease Control, “National Action Plan to Combact Multidrug-resistant Tuberculosis,” MMWR, 41 No. RR-11 (1992): 1–48.Google Scholar
Bayer, R., Dubler, N.N., Landesman, S., “The Dual Epidemics of Tuberculosis and AIDS: Ethical and Policy Issues in Screening and Treatment,” Am J Public Health, 83 (1993): 649–654.CrossRefGoogle Scholar
Centers for Disease Control, “Tuberculosis and HIV Infection: Recommendations of the Advisory Committee for the Elimination of Tuberculosis (ACET),” MMWR, 38 (1989): 236–250.Google Scholar