The acquired immunodeficiency syndrome: a tuberculosis threat?

In the United States there has been an increase in mycobacterial infections that is attributable to the acquired immunodeficiency syndrome (AIDS). Since 1983, when the first case of AIDS was reported in Australia, there have been 523 patients (to June 30, 1987) notified with group-IV AIDS and, of these, 361 (69%) cases have been in New South Wales. Of these 361 notifications, 59 (16%) patients have had concurrent mycobacterial infection. Seven of these patients had Mycobacterium tuberculosis infection and five of these infections occurred in 1986. This means that, in 1986, patients with group-IV AIDS had a rate of infection with Myco. tuberculosis of 3000 per 100,000 population, compared with 5.2 cases per 100,000 population for New South Wales. We sought to determine whether or not there was any unexplained increase in notifications which might be attributable to AIDS. This paper reports cases that were notified to the AIDS and tuberculosis registers, finds that atypical mycobacterial infections are underreported by at least 19.5%, and examines trends in notifications for mycobacterial disease since the onset of the AIDS epidemic. It also raises the importance of appropriate measures to protect health workers from tuberculosis.