Mycobacterioses and the Acquired Immunodeficiency Syndrome

AIDS and HIV infection have now been recognized as conditions causing immunosuppression associated with an increased risk of mycobacterial disease, caused especially by M. avium complex and M. tuberculosis. In addition, disseminated disease due to other mycobacteria, heretofore considered nonpathogenic, is now being reported. The epidemiologic and clinical features of mycobacteriosis in patients with AIDS or HIV infection are unusual and distinctive. The high incidence of disseminated disease due to M. avium complex and the extent of infection, with abundant organisms in tissues and overwhelming mycobacteremia, is certainly unprecedented. Currently available treatment for this infection is unsatisfactory. The clinical features of tuberculosis in these patients with AIDS or HTLV III/LAV infection are often unusual, with a high frequency of extrapulmonary disease, and a relative infrequency of classical apical, cavitary disease in the lung. Nevertheless, tuberculosis in these individuals appears to respond to therapy and is potentially preventable. The interaction of tuberculous infection with HIV infection in the population has created new clinical syndromes that present a challenge to the diagnostic and therapeutic skills of clinicians.