| 1. Title: AIDS and mycobacterial diseases. Author: Ponnighaus JM Source: [Unpublished] [1987]. 15, [3] p. Abstract: The interaction between AIDS virus infection and Mycobacterial diseases, i.e., tuberculosis and leprosy, is presented in terms of preliminary data from the Karonga district in Malawi, and in view of desirable research goals. For each mycobacterial disease, the 2 questions are asked: are people infected with HIV more or less likely to develop leprosy or TB? And what are the effects of HIV infection in those with leprosy or TB? The Karonga district has 140,000 people, about 70,000 between 15-50 years, and a leprosy incidence of 1.2/1000 yearly. The HIV seropositive rate is about 5%, although facilities for serum tests are limited, and AIDS is usually diagnosed clinically. It would be impossible to detect a change in incidence in leprosy due to HIV, since only 4 cases of HIV in leprosy patients should be expected. Data on leprosy in Karonga vary widely because of variations in case-finding and reporting. TB diagnosis has improved because of emphasis on sputum collection and recent introduction of bacterial culturing facilities at health centers. At the least, careful monitoring of HIV in leprosy patients, and of leprosy in AIDS patients is indicated. Theoretically, it is unlikely that leprosy should increase because of HIV infection, since the leprosy organism spreads so slowly. It is possible, however, that without cell-mediated immunity, the clinical type of leprosy could go from the pauci- to the multibacillary or lepromatous form. Only 1 case report has appeared of leprosy in an AIDS victim. For TB, it is known that AIDS is associated with clinical TB, especially in urban areas. Local data in Karonga show an increase in incidence of clinical TB since 1980, although whether this is due to better case reporting is unknown. For both mycobacterial diseases it is suggested that case-control studies with adequate controls be done to see whether leprosy or TB is associated with HIV seropositivity. Then cohort studies should be performed to monitor incidence of TB among HIV-positive and - negative persons and their contacts. Since there is no treatment for AIDS, it would be feasible and ethical to do these studies only if subjects were rewarded for their cooperation by treatment of other conditions. For example, fertile women could be recruited, followed and treated simultaneously during each pregnancy. Language: English Keywords: DISEASES | BACTERIAL AND FUNGAL DISEASES | INFECTIONS | COMMUNICABLE DISEASES | TUBERCULOSIS | VIRAL DISEASES | HIV INFECTIONS | AIDS | DIFFERENTIAL MORTALITY | RESEARCH METHODOLOGY | DATA COLLECTION | LONGITUDINAL STUDIES | HEALTH SURVEYS | CASE STUDIES | COMPARATIVE STUDIES | CONTROL GROUPS | COHORT ANALYSIS | PREGNANCY | ANTENATAL CARE | Mortality | Population Dynamics | Demographic Factors | Population | Studies | Health | Reproduction | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care Document Number: 046902 |
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