TUBERCULOSIS IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - 22 CASES

A retrospective study of 22 bacteriologically documented cases of tuberculosis associated with HIV1 positivity was carried out in the department of infectious diseases of Marseille, south of France, a high prevalence area for HIV infection. Sixty-seven percent of the patients were intravenous drug abusers. Thirty-two percent were classified as having AIDS prior to the diagnosis of tuberculosis. All but one had M. tuberculosis isolated from bronchopulmonary samples; 5 had no parenchymatous radiological abnormalities, 5 had excavated lesions. Four patients had cervical adenopathies, 4 other patients had asymptomatic extra-pulmonary sites of infection. All patients responded well to chemotherapy; no relapse was observed during or after treatment. Eight died, two of them before treatment (cause of death unknown), 6 from other complications of AIDS within the 2 years following the diagnosis of tuberculosis. The low incidence of extra-thoracic involvement and the high frequency of excavated pulmonary lesions are discordant with most US studies, as is the relatively late onset of tuberculosis in the course of HIV infection. We suggest that different local epidemiological factors and maybe the practice of systematic BCG vaccination during childhood in France could contribute to these differences.