Why disease due to Mycobacterium tuberculosis is less common than expected in HIV-positive patients in Edinburgh

By December 1993, only five cases of tuberculosis were observed in the 1030 HIV-positive patients in Edinburgh, U.K., although, on the basis of historical tuberculin skin test data, between four and eight new cases of tuberculosis were expected per year. Of 310 HIV-positive patients, none of the 19 (6.1%) who were tuberculin skin test positive had developed tuberculosis after 87 months (average) of follow-up. It is suggested that new or re-infection is a more common cause of tuberculosis in HIV-positive patients than reactivation. Restriction fragment length polymorphism typing of Mycobacterium tuberculosis strains could confirm this hypothesis and support currently suggested additional infection control procedures.