The microbiological aspects of the interaction between tuberculosis and the human immunodeficiency virus in an urban African centre

Brindle, Richard (1993) The microbiological aspects of the interaction between tuberculosis and the human immunodeficiency virus in an urban African centre. University of Southampton, Doctoral Thesis.

Abstract

This thesis examines two aspects of the relationship between tuberculosis (TB) and the human immuno-deficiency virus (HIV): The bactericidal response to standard TB treatments and the infective causes of morbidity in HIV-negative and HIV-positive patients with tuberculosis.

In the first part, 122 patients with culture proven pulmonary tuberculosis were recruited to examine the concentrations of Mycobacterium tuberculosis in the sputum and the relationshp to HIV-1 antibody status. They were followed for one month from the start of anti-tuberculous chemotherapy to assess the early bacillary response to two drug regimes. The mean initial concentration of M.tuberculosis in the sputum of the HIV-negative patients was significantly higher than in that of HIV-positive patients. The HIV-positive patients had less radiological evidence of disease and significantly fewer zones of the lung affected with cavities. The response to treatment was similar in both patient groups.

The second part examined the role of acute infection in patients with TB by documenting morbid events in patients on anti-tuberculous treatment. 163 HIV-negative and 235 HIV-positive patients were recruited, with a total of 438 events. There were significantly more HIV-positive patients with two or more events than HIV-negative patients. HIV-positive patients were more commonly bacteraemic and often presented with focal infection. Anti-tuberculous treatment alone is not sufficient to manage HIV-associated tuberculosis in Africa.

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