SYMPTOMS and SIGNS
Tuberculosis in patients with HIV usually presents with fever, sweating at night, weight loss, fatigue and cough. Chest Xray usually demonstrates abnormal densities. In previously healthy individual tuberculosis usually produces cavities in the lungs; however because of their depressed immune response patients with HIV and tuberculosis rarely form cavitary lung lesions. Tuberculosis in HIV patients can be mistaken for other forms of bacterial pneumonia. The organism is also more likely to spread throughout the body and cause meningitis.
Tuberculosis in HIV patients can be very severe and is often fatal. Early diagnosis and treatment are critical. Four anti-tuberculous drugs are recommended for initial therapy and usually includes Isoniazid, rifapampin, ethambutol and pyrazinamide. Therapy must be continued for 9 months. There remains no effective vaccine for tuberculosis.
CAUSES and RELEVANCE to FLORIDA
Because Florida has a large population of immigrants from underdeveloped countries where tuberculosis is common, this disease remains a major health problem in our state. The disease is spread from person to person by coughing and is usually spread among families and in crowded environments. HIV is also common in Florida. It is estimated that 1 out of every 100 Floridians age 18-30 has HIV. Because HIV patients have depressed immunity they are more susceptible to tuberculosis and if they come in contact with someone with active disease they are much more likely to develop disease and when infected tend to have large numbers of organisms in their lungs making them more likely to spread their infection to others.
Aggressive public health measures are critical for controlling both HIV and tuberculosis. Once a patient is diagnosed with tuberculosis, all contacts must be tested for tuberculosis exposure using a PPD skin test. Those with positive tests or with a clear history of close contact need to receive isoniazid preventative treatment for 6-9 months. Sadly in many areas of Florida HIV is a disease that must be kept secret because of the stigma associated with being infected. This secrecy has hindered case finding and preventive measures. Forthright education programs warning of the dangers of promiscuous sexual activity and intravenous drug abuse are critical for reducing the incidence of this disease in Floridians.
Prepared by Frederick Southwick, M.D.
Professor of Medicine and Chief of Infectious Diseases
University of Florida College of Medicine
For more information see Infectious Diseases in 30 Days, McGraw-Hill, 2003, pg 137-146; 477-524.