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Tuberculosis -- United States, 1985 -- and the Possible Impact of Human T-Lymphotropic Virus Type III/ Lymphadenopathy-Associated Virus Infection

In 1985, a provisional total of 21,801 tuberculosis cases was reported to CDC, a 2.0% decline from the 1984 final total of 22,255 cases. Similarly, in 1985, the provisional incidence rate was 9.1 per 100,000 population, a decline of 3.2% from the 1984 final rate of 9.4/100,000. Compared with 1983, the number of reported cases in 1984 declined progressively, so that by week 52, there were 2,139 fewer cumulative provisional reported cases (Figure 5). Compared with 1984, there was no such progressive decline in 1985. Reported by Div of Tuberculosis Control, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: From 1975 through 1978, the average annual decrease in reported tuberculosis cases was 5.7%. From 1978 through 1981, when there was a large influx of Southeast Asian refugees, the average decline was only 1.4%. The average decline of 6.7% from 1982 through 1984 indicated that the previous downward trend had resumed. The 2.0% decline in 1985 thus represents another slowing of this trend.

Although the reasons for the relatively small decline in 1985 cases are not fully known, evidence supports the hypothesis that human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) infection of persons infected with the tubercle bacillus has caused an increase in tuberculosis in some areas.

The suspicion that HTLV-III/LAV infection may be responsible for increased tuberculosis morbidity is based on the following:

  1. Since other immunosuppressive disorders are associated with an increased risk of developing clinically apparent tuberculosis (1,2), there is a theoretical reason to believe that compromised immunity secondary to HTLV-III/LAV infection may favor activation of preexisting latent Mycobacterium tuberculosis infection.

  2. Some of the areas with the largest tuberculosis morbidity increases this year (New York City, California, Florida, Texas) are also some of the areas that have reported the largest number of acquired immunodeficiency syndrome (AIDS) cases to date (3).

  3. Data from New York City indicate that increased tuberculosis morbidity is occurring in areas of the city where most AIDS cases have occurred. Matching the New York City tuberculosis and AIDS case registers has revealed increasing numbers of AIDS patients with histories of tuberculosis. An increasing number of persons with histories of intravenous drug abuse--a known risk factor for AIDS--have been diagnosed as having tuberculosis (4).

  4. In Dade County, Florida, a substantial number of persons with AIDS either had tuberculosis at the time AIDS was diagnosed or had it within the 18 months preceding the AIDS diagnosis (5). Based on an analysis currently in progress, 109 (10.0%) of the 1,094 AIDS patients reported to CDC from Florida through December 31, 1985, have also been diagnosed with tuberculosis. To better understand the problem and to design the most effective

and efficient program strategies, it will be essential to establish as soon as possible: (1) the proportion of tuberculosis patients who also have AIDS; (2) the proportion of specific subpopulations with tuberculosis that have HTLV-III/LAV infection; (3) the proportion of AIDS patients who have had tuberculosis diagnosed; (4) the relative risk among persons with both tuberculosis infection and HTLV-III/LAV infection of developing clinical tuberculosis, compared with suitable controls with tuberculous infection; (5) whether patients with HTLV-III/LAV infection and tuberculosis are more or less likely to transmit tuberculosis infection to others; (6) the validity of tuberculin skin-test results for persons with AIDS or HTLV-III/LAV infection; and (7) the efficacy of current treatment regimens among patients with HTLV-III/LAV infection and tuberculosis.

CDC's Division of Tuberculosis Control, Center for Prevention Services, is working closely with the Florida and Dade County health departments and the New York City Department of Health in designing and conducting studies to obtain answers to these questions.

References

  1. Williams DM, Krick JA, Remington JS. Pulmonary infection in the compromised host. Part II. Am Rev Respir Dis 1976;114:593-627.

  2. Millar JW, Horne NW. Tuberculosis in immunosuppressed patients. Lancet 1979;I:1176-8.

  3. CDC. Table III. Cases of specified notifiable diseases, United States, week ending December 28, 1985 and December 29, 1984 (52nd week). MMWR 1986;34:784.

  4. Stoneburner RL, Kristal A. Increasing tuberculosis incidence and its relationship to acquired immunodeficiency syndrome in New York City. Atlanta, Georgia: International conference on acquired immunodeficiency syndrome (AIDS). April 14-17, 1985.

  5. Pitchenik AE, Cole C, Russell BW, Fischl MA, Spira TJ, Snider DE. Tuberculosis, atypical mycobacteriosis, and the acquired immunodeficiency syndrome among Haitian and non-Haitian patients in South Florida. Ann Intern Med 1984;101:641-5.



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