Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
Newsday - August 4, 2000
Laurie Garrett, Staff Writer
People infected with the virus that causes AIDS are highly susceptible to tuberculosis infection and more likely, once infected, to develop full-blown tuberculosis. Indeed, if TB bacteria are in their bodies, HIV-positive individuals are 800 times more likely to get active tuberculosis compared with those who are HIV-free.
Though the numbers of active tuberculosis cases identified in the United States have fallen steadily since 1994, there were 17,000 last year, TB is clustering at high rates among the same groups of Americans who are most likely to be HIV positive: intravenous drug users, minority gay men and recently incarcerated African-American and Hispanic men.
Epidemiologist Suzanne Marks and her colleagues at the CDC's Division of Tuberculosis Elimination studied TB screening conducted in 11 urban hot spots from July, 1996, to July, 1997, especially Manhattan and Brooklyn. Physicians are required to notify local public health officials whenever they diagnose an active TB case. And the officials are supposed to follow up, monitoring treatment of the TB cases and interviewing their families and close associates to ensure that the disease has not spread among them.
Of 6,225 such family and associate contacts screened in the 11 cities, public health officials failed to determine the HIV status of 87 percent. In other words, despite realizing that HIV patients are at acute risk for tuberculosis, the officials most of the time made no attempt to link the two in their investigations.
"It's something that needs to be done more often," Marks insisted in an interview.
There may be sound excuses for failing to link TB and HIV screening. A key one: HIV-positive people have depleted immune systems. As a result, they often fail to mount a response to the TB skin test. So standard testing yields falsely negative results.
Marks says all public health departments in the United States should, therefore, screen HIV-positive people for tuberculosis in three ways: with a skin test, chest X-ray and full medical workup for TB symptoms.
TB contacts may not be getting HIV-tested because most public health departments are still using old blood tests that take two weeks to process. By the time lab results come in, the investigations are closed. Marks thinks newer, rapid HIV tests should be used by all TB investigators: some reliable saliva or pin-prick blood drop tests can give results in just 20 minutes.
Linking HIV and TB testing would be of great benefit to people infected with the AIDS virus. If found to be infected with both microbes, the HIV positive individual can be spared the life- threatening consequences of tuberculosis with just two months of antibiotic therapy.
Can such an approach have the reverse effect, lowering the TB contagion risk to the HIV-negative population? On that point there is considerable controversy. As yet unpublished CDC data indicates that most HIV-positive individuals get forms of tuberculosis that aren't terribly contagious because the bacteria colonize the body's interior, rather than the lungs. Italian researchers from the University of Turin recently published evidence in Lancet that contagious TB is more commonly seen in patients with advanced AIDS.
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