TUBERCULOSIS IN AFRICANS HOSPITALIZED IN PARIS - IMPACT OF HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Objectives: Human immunodeficiency virus (HIV) infection has greatly modified the epidemiology and clinical course of tuberculosis, The aim of this study was to analyze the characteristics of tuberculosis in African patients hospitalized in Paris by comparing clinical features in patients with and without HIV infection. Methods: Hospital records of 71 patients from Africa hospitalized between 1989 and 1992 in Paris with a certain or probable diagnosis of tuberculosis were studied retrospectively. Results: There were 30 patients (42%) with HIV infection. In 12 of them (40%) HIV positivity was discovered at diagnosis of tuberculosis, Age, sex, and duration of residence in France before diagnosis were similar between HIV+ and HIV- patients, Pulmonary tuberculosis was found in 23 patients and extrapulmonary forms (mainly lymph node involvement) were seen in 34; both in 14 patients, There was no difference in localization between HIV+ and HIV- patients except for disseminated tuberculosis which was more frequent in HIV+ patients, Skin reactions to tuberculin were positive in 76% and 97% of the HIV- and HIV+ patients respectively (p < 0.02), Drug resistance was observed in 8 patients (6 HIV+): streptomycin (n=6), pyrazinamide (n=2), isoniazide (n=2), ethambutol (n=1) and rifampicin (n=1), Drug therapy was successful in controlling the initial manifestations of tuberculosis in both HIV+ and HIV- patients. Conclusion: Extrapulmonary forms of tuberculosis, especially lymph node infection was more frequent in Africans hospitalized in Paris, whether the patients were HIV positive or negative, HIV infection was associated with disseminated tuberculosis, nonexcavated pulmonary tuberculosis and undesirable side effects of antituberculosis drugs.