Epidemiology

HIV-Positive Patients At Particular Risk Of
TB In Japan

TOKYO, Apr 13 (Reuters) - Tuberculosis researchers
in Japan are concerned that many HIV-positive
patients are at high risk for reactivated TB, which
may often go undiagnosed.

Dr. Toru Mori of the Research Institute of
Tuberculosis in Tokyo and colleagues have organized
a voluntary reporting network for TB associated with
HIV infection. By the end of 1996, Dr. Mori reports
that a total of 71 cases had been reported, of which
59 were true TB and 12 were non-tuberculous
mycobacteria (NTM) cases. Ninety-seven percent of
the TB cases were confirmed bacteriologically.

Patients coinfected with HIV and TB typically had
severe immunological impairment, with 79% of the
cases having CD4 cell counts of less than 100. The
route of HIV infection included 51% heterosexual,
13% homosexual and 13% through blood preparations.
Only 11% of the patients with TB had past history of
TB treatment.

Dr. Mori told Reuters Health that, "Our concern is
that Japan has a heavy burden of tuberculosis that is
about four times higher than that of the USA and
other industrialized countries in terms of new case
rate. Therefore, once the Japanese get infected with
TB bacilli, they can quite easily develop
tuberculosis. This is particularly true for those aged
40 years or older of whom more than 30% have
already been infected with TB."

"Japanese doctors are not very aware of this, and I
am afraid that HIV-positive patients seen by them
may have undiagnosed TB. This may in turn become a
threat of infection not only to the family members of
the patients, but also to other people in contact
[with them], including healthcare personnel and
volunteers."

Japanese society and public health service systems
are "too nervous about the privacy of HIV-infected
persons," Dr. Mori added. This makes the surveillance
of HIV and of TB among HIV-infected persons
difficult, he noted.

Dr. Mori and his colleagues plan to establish a forum
to collect information of TB/HIV problems in Japan.

Kekkaku [Tuberculosis]1997;72:649-657.

by Sandra Katzman