Mycobacterium tuberculosis in the acquired immunodeficiency syndrome

Patients with human immunodeficiency virus (HIV) infection, with or without the diagnosis of acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC), have an increased incidence of tuberculosis, especially of an extrapulmonary nature. The condition is associated with significant morbidity and mortality. The reported incidence of the combination of tuberculosis and AIDS varies between 4% and 10% of AIDS patients, with a higher incidence noted in the male, inner-city, intravenous-drug-abuser population. Clinical findings may reflect the site of infection, but are often nondiagnostic. Diagnosis often requires biopsy for histopathologic evaluation and tissue culture to document the presence of granulomas and mycobacterial organisms. Universal body fluid precautions among these patients are mandatory, and respiratory isolation should be maintained during diagnostic evaluation and early treatment. These patients usually respond to standard antituberculosis therapy. Physicians should maintain a high index of suspicion of tuberculosis in patients with HIV infection. Conversely, the diagnosis of HIV infection should be considered in patients with unusual manifestations of tuberculosis. Because tuberculosis is one of the few potentially curable infections in the AIDS patient, recognition of its presence is crucial.