[Tuberculosis and the HIV pandemic. Risk of nosocomial tuberculosis infection].

Spread of human immunodeficiency virus (HIV) infection has had a major impact on the epidemiology of tuberculosis. In several African countries the incidence of tuberculosis has doubled, and the prevalence of HIV infection among patients with tuberculosis is 20 to 60%. A similar change has occurred in some developed countries. Several factors, including HIV infection, have contributed to this change. Tuberculosis among HIV infected patients is probably more often a result of a new infection with Mycobacterium tuberculosis than reactivation of a latent infection. In the USA in particular several outbreaks of multidrug-resistant tuberculosis have been reported. The mortality among patients has been high, and there have been several cases of transmission to healthcare workers. Analyses of these recent outbreaks indicate that it is possible to intervene by well known prophylactic measures. Rapid diagnosis and treatment, and correct isolation procedures are essential to prevent outbreaks.