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:
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.
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).
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).
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
Williams DM, Krick JA, Remington JS. Pulmonary infection in
the
compromised host. Part II. Am Rev Respir Dis
1976;114:593-627.
Millar JW, Horne NW. Tuberculosis in immunosuppressed
patients.
Lancet 1979;I:1176-8.
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.
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.
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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