The resurgence of tuberculosis.

The resurgence of tuberculosis has been documented in both developed and developing countries and is associated with the spread of human immunodeficiency virus (HIV) infection. In the USA, the steady decline in the incidence of tuberculosis witnessed during the past three decades has halted, and since early 1986, a resurgence of tuberculosis has been noted. A similar change in trend has occurred in the West, for example Britain and continental Europe. The present problem is aggravated by the emergence of multiply drug resistant (MDR) strains of Mycobacterium tuberculosis. While drug resistance is not a new phenomenon, it had not hitherto been experienced in combination with HIV infection. Previously, MDR tuberculosis was indolent, slowly progressive and usually restricted to the lungs. However, in the setting of an HIV-infected patient it is often systemic, aggressive, difficult to treat and associated with early mortality. In New York State, many of the population 'at risk' of contracting tuberculosis, as well as of HIV infection have been incarcerated. This provides a public health opportunity to intervene to prevent and treat both of these diseases.