Portal de Periódicos da CAPES

Tuberculosis and Human Immunodeficiency Virus Infection in Italy

1991; Elsevier BV; Volume: 100; Issue: 2 Linguagem: Inglês

10.1378/chest.100.2.586

1931-3543

Giorgio Antonucci, Orlando Armignacco, Enrico Girardi, Giuseppe Ippolito, Gioacchino Angarano, Sergio Babudieri, Alessandra Bini, Patrizia Bottura, Paolo Costigliola, Antonietta Cargnel, Antonio Chirianni, Ivo Maria Crosato, Giovanni Di Perri, Isabella Errante, Massimo Fantoni, Massimo Galli, P. Guarascio, Luigi Isabella, Marco Libanore, Elio Manzilo, Lorenzo Minali, Gabriella Pagano, Tiziana Quirino, Stefania Salmaso, Domenico Santoro, Fredy Suter, Antonio Traverso, Gianmarco Vigevani,

HIV/AIDS drug development and treatment

To the Editor: Infection with the human immunodeficiency virus (HIV) reflects and magnifies diseases that are endemic in a particular country.1Reichman LB Tuberculosis as a manifestation of the acquired immunodeficiency syndrome [letter]..JAMA. 1986; 256: 3093Crossref Google Scholar The incidence of tuberculosis in HIV-infected patients depends on the overlap between HIV-seropositive subjects and the population previously infected with tuberculosis.2Watson JM Gill ON HIV infection and tuberculosis..Br Med J. 1990; 300: 63-65Crossref PubMed Google Scholar Even before the acquired immunodeficiency syndrome (AIDS) epidemic, intravenous (IV) drug abusers were considered at special risk for tuberculosis in the United States.3Reichman LB Felton CP Edsall JR Drug dependence: a possible new risk factor for tuberculosis disease..Arch Intern Med. 1979; 139: 837-839Crossref Scopus (150) Google Scholar This risk substantially increased after HIV spread. Tuberculosis should be expected to occur frequently among HIV-infected persons in Italy. In fact, about 150,000 subjects are estimated to use illicit IV drugs in Italy, and HIV seroprevalence has been shown to range from 20 to 60 percent in this group.4Rezza G. Regional variation of HIV seroprevalence among injecting drug users in Italy. Rev Epidemiol Sante Publique (in press)Google Scholar Intravenous drug abusers represent the largest number of AIDS patients (67.2 percent of the 6,068 AIDS cases reported as of March 31, 1990, according to a report from the Italian Ministry of Health). Moreover, tuberculosis is still endemic in Italy, and about 20,000 new cases are estimated to occur each year (National Research Council, unpublished data, 1987). In order to evaluate the magnitude of the association between tuberculosis and HIV infection in our country, the Italian Multicentre Study Group on Tuberculosis and AIDS was set up in 1988, supported by a grant from the Italian Ministry of Health. Twenty-one departments of infectious diseases and 15 pneumologic departments located in the most important urban areas collaborate in this group. As of July 1990, the coordinating center has collected data from all 21 departments of infectious diseases. Tuberculosis cases that occurred from 1985 to 1989 among HIV-infected subjects were reviewed. A total of 306 episodes of bacteriologically proved tuberculosis were observed; in 142 of them, sputum culture was positive for Mycobacterium tuberculosis. Annual proportions of tuberculosis in HIV-infected patients observed during the study period are shown in Table 1. A significant increase in prevalence was found from 1985 to 1989. On average, IV drug abusers represented 73.5 percent of HIV-seropositive subjects seen each year; no significant difference in the prevalence of tuberculosis was found between IV drug abusers and nonabusers. The observed increase in tuberculosis in our patients could be explained, at least in part, by an increase in HIV-infected subjects progressing to symptomatic stages.Table 1Occurrence of Tuberculosis in HIV-infected Subjects in 1985 to 1989HIV-infected SubjectsYearTotal No.No. of Subjects with AIDSNo. of Subjects with Tuberculosis*Values in parentheses represent percentage of total number of HIV-infected subjects (p<10−6 by χ2 analysis). Values in brackets represent 95 percent confidence limits.19851,3801235 (0.36[0.12-0.85])19862,85722727 (0.95[0.62-1.37])19874,71444949 (1.04[0.77-1.37])19885,63392075 (1.33[1.05-1.69])19896,5041,235150 (2.31[1.95-2.71])* Values in parentheses represent percentage of total number of HIV-infected subjects (p<10−6 by χ2Watson JM Gill ON HIV infection and tuberculosis..Br Med J. 1990; 300: 63-65Crossref PubMed Google Scholar analysis). Values in brackets represent 95 percent confidence limits. Open table in a new tab Our data show that tuberculosis is an emerging problem among HIV-infected persons in Italy. In comparison with other Western countries (chiefly the United States and Great Britain), some particular features stand out. In Italy, where circulation of M tuberculosis is elevated, the population with both HIV and tuberculous infections is likely to be so large that the risk of tuberculosis in HIV-infected subjects does not seem to be restricted to IV drug abusers.