HIV infection is responsible for an increased incidence of pulmonary
tuberculosis (TB) in several areas of the world. In general, active TB
happens as a consequence of a recently acquired exogenous infection of
Mycobacterium tuberculosis or of endogenous reactivation of old
infection. In some regions, besides the increase of the incidence, an
important change in the dynamics of the transmission of M.
tuberculosis took place. This change was more evident in closed places
(hospitals, prisons, housings) where the prevalence of inmates infected by
HIV is high. The infection by HIV also interferes with the diagnosis of TB,
especially in patients in the advanced form of the HIV infection. In these
cases, the clinical picture of TB is quite similar to other opportunistic
infections . HIV seropositive patients tend to stay longer in hospitals,
increasing the risk of transmission of TB or even of multidrug resistant TB
(TB-MDR) to other patients, health care workers and students in teaching
institutions (Alland et al. loc. cit., Frieden et al. loc.
cit.). The clinical evolution of co-infected patients is diverse from
immunocompetent individuals, with higher rate of adverse drugs reaction and
mortality. The emphasis given in the last decades to outpatient treatment
of TB should be now revised in areas with high rate of TB and AIDS,
especially in great urban centers. Hospital treatment of tuberculosis
patients with co-morbidities, such as AIDS, is much more common now. Should
be taken into account in the elaboration of public politics the occurrence
of TB in general hospitals, above all in developing countries, such as
Brazil.
