The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

HIV INFECTION AND PULMONARY TUBERCULOSIS 39
were small, non tender and responsive to antituberculosis
treatment. She was discharged on
16.4.1991 and is being followed up.
Discussion
Reports from various parts of the world
indicate that the frequency of infection with the
human immunodeficiency virus is increasing
every year, at least among the high risk groups.
Due to an interrelation between tuberculosis and
AIDS, evidently depending on the level of
infection by these respective pathogens in the
same population, the problem of tuberculosis is
assuming greater importance in every country. It
is known that the prevalence of infection with M
tuberculosis in India is 30.4% (It ranges from
35.7% in the age group 20-24 to 65.9% in the age
group 45-48 years). The dimension of the
problem of tuberculosis might, therefore,
increase with the coming in of AIDS.
Table 2 shows the peculiar radiographic
features of tuberculosis among patients with
AIDS reported in literature and our own
experience of tuberculosis patients co-infected
with HIV.
Our series had a strikingly higher incidence of
poor tolerance to anti-tuberculosis chemotherapy
(4 out of 6) compared to experience of other
authors. The case fatality rate among those
having AIDS and tuberculosis is very high (76%).
The cause of death is almost always AIDS, not
tuberculosis. We came across 2 deaths out of 6
persons with HIV infection and TB disease.
Except case 6, with extra pulmonary
manifestation, our cases did not satisfy the
Centers for Disease Control, Atlanta 4 criteria for
being labelled as full-blown cases of AIDS. The T
cell typing employing Dako Technique showed a
low T4/T8 ratio on account of an increase in T8
cells.This might be because the patient had not
yet reached the stage of immunosuppression. As
has been pointed out by Pitchenick et al (loc cit)
M. tuberculosis being a more virulent organism
would be expected to cause disease at an earlier
stage of immuno-suppression among tuberculosis
infected patients who have or are developing the
syndrome. It is quite possible that some of our
cases contracted HIV infection after developing
pulmonary tuberculosis. The response to
chemotherapy was good in 4 out of our 6 cases.
The knowledge of the clinical profile and
evolution of disease under Indian conditions
might be of help in evolving strategies of control
and case management.
Acknowledgement
We are grateful to Dr. Jacob John, Professor
& Head of Dept. Microbiology, CMC, Vellore
for carrying out the tests, the Director, JIPMER
and Director, Health and Family Welfare
Services, Government of Pondicherry for
permission to publish this paper. The secretarial
assistance rendered by Smt. Krishnakumari is
also acknowledged.
References
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