Tuberculosis among patients with AIDS and a control group in an inner-city community.

BACKGROUND: Tuberculosis, the largest single cause of death of any infectious disease worldwide, has undergone a startling resurgence in the United States, partially related to the acquired immunodeficiency syndrome (AIDS) epidemic. METHODS: To compare the clinical, roentgenographic, and bacteriologic characteristics of patients with AIDS and the general population, we retrospectively analyzed the clinical records of all patients with tuberculosis in an inner-city population over a 4-year period. Forty-six patients with AIDS (including 38 injecting drug users [83%]) were identified and matched with a control group of 46 patients with tuberculosis who did not have AIDS. RESULTS: Forty-one patients with AIDS (89%) had pulmonary tuberculosis; 10 (22%) had disseminated disease and 13 (28%) had concurrent extrapulmonary disease. Among the patients without AIDS, two (4%) had disseminated disease and four (9%) had extrapulmonary disease. Patients with AIDS were far more likely to be black. Thirty-seven patients with AIDS (80%) had negative purified protein derivative skin test results compared with eight controls (17%). Seventeen (41%) of 41 patients with AIDS presented with classic post-primary upper-lobe disease compared with 32 (73%) of 44 patients in the control group. Primary tuberculosis features occurred predominantly in the AIDS group. Four (10%) of 41 patients with AIDS presented with clear chest films despite positive smears and cultures. Nine patients with AIDS (20%) were drug-resistant compared with three controls (7%). Seven patients with AIDS with drug resistance were born in the United States (78%), while all controls with drug resistance were foreign-born. CONCLUSIONS: We found vast differences in the clinical, roentgenographic, and drug susceptibility characteristics of patients with tuberculosis who did and did not have AIDS.