TB’s Resurgence Probably Due to AIDS, Officials Say
Tuberculosis, a disease that has been steadily declining in the United States since the 1950s, is making a dramatic comeback that is probably linked to the AIDS epidemic, according to federal and local public health officials.
The officials note that areas with the largest increase in tuberculosis, including New York City and California, are identical to those with the highest rates of acquired immune deficiency syndrome. They say new research indicates that the onset of tuberculosis may provide an early warning of AIDS in high-risk groups.
More ominously, they said, the startling and unexpected drop in the rate of decline of tuberculosis this year suggests that, if AIDS continues to spread, it is likely to aggravate the global tuberculosis problem. Worldwide, there are 8 million to 10 million new TB cases each year.
“It is of great concern both for this country and for the rest of the world,” said Dr. Dixie Snider Jr., director of the division of tuberculosis control for the federal Centers for Disease Control. “Tuberculosis is a very serious problem in developing countries, such as in Africa, where AIDS is also very high.”
Snider and others studying the connection between tuberculosis and AIDS said the highly communicable tuberculosis bacteria can infect an individual but remain dormant and harmless for many years unless the immune system is somehow impaired. AIDS destroys the body’s immune system.
Studies in New York City, which has the highest number of AIDS cases in the country, have shown a rise in tuberculosis during the last four years among AIDS patients, many of whom are homosexuals or intravenous drug users.
“This is not as a result of the spread of tuberculosis but is a reactivation of infection that was acquired many years ago,” said Dr. David Sencer, New York City commissioner of health. “Now, with the (AIDS) infection damaging the immune system, the body cannot contain the bacteria of the disease, and it becomes a serious infection for the individual.”
As of Nov. 15, there were only 53 fewer cases of tuberculosis nationwide than in 1984, contrasted with a predicted drop of 2,000 based on trends of previous years, according to the CDC. Areas reporting the largest increases in tuberculosis in 1985 were New York City, California, Texas, upstate New York, Florida and Massachusetts.
In New York City, tuberculosis deaths jumped from just one in 1978 to 23 last year and 25 in 1985 as of Nov. 8. Sencer said New York has seen a similar increase in pneumonia among AIDS patients, raising speculation that other diseases may also appear as a result of AIDS.
Snider said the CDC recently began controlled studies in New York City and Florida to test people diagnosed with tuberculosis to see if they have also been exposed to HTLV-III, the virus that causes AIDS.
“Preliminary information suggests a high proportion of cases in New York City are infected with the AIDS virus,” Snider said. “But we have to get a larger number to draw more firm conclusions.”
He said the CDC would issue recommendations for the public and the medical community in several weeks related to “who to screen for tuberculosis, what preventive measures to take and what forms of tuberculosis AIDS patients get.”
Typically, AIDS leaves the victim powerless against rare “opportunistic” infections, most often Kaposi’s sarcoma, a rare skin cancer, and pneumocystis carinii pneumonia, a parasitic lung disease.
But tuberculosis is not considered an “opportunistic” infection because it is much more virulent than other infections associated with AIDS and has the potential to strike victims not already weakened by AIDS, Snider said.
Snider said AIDS victims often contract a form of tuberculosis that affects organs other than the lungs, such as the kidneys, bones, lymph nodes and brain. Thus, he said, it is important that TB be accurately diagnosed “because it is contagious and can be transmitted.”
Also, he said, unlike opportunistic infections, tuberculosis--even in AIDS patients--responds very well to the standard treatment with antibiotics.
In AIDS victims, tuberculosis often can appear even before the symptoms of AIDS itself, federal officials said. “You can often see tuberculosis as the first clinical evidence of HTLV-III infection,” said Dr. Harold Jaffe, chief epidemiologist for CDC’s AIDS task force.
Snider said that federal health officials first recognized a connection between TB and AIDS in 1983 when “a number of patients in Florida with tuberculosis subsequently developed AIDS.”
Last April, he said, they began to see the link reflected in national trends. By the week ending Sept. 28, there were 15,839 cases, only 66 fewer than for the same period in 1984, according to CDC figures. A year earlier, by contrast, there were 1,514 fewer cases than in the same period in 1983.