Tuberculosis Consultant Services

HIV infected patients frequently develop disseminated tuberculosis as this study from Dar es Salaam in Tanzania demonstrates.

Patients admitted to the hospital with fever were tested for HIV and had blood cultures to determine the cause of fever. Among HIV infected patients 20% had M. tuberculosis isolated from blood.  Almost half of these patients had no respiratory tract signs or symptoms, and almost half of the patients died during hospitalization.

This and other studies (including autopsy studies) show that probably a large proportion of HIV infected patients in sub-Saharan Africa succumbs to tuberculosis without ever been known to have tuberculosis.

In this study, blood cultures were taken from the patients, but the practice was discontinued after the study, simply because it was not feasible even in the national referral hospital to make such an expensive investigation among all patients presenting with HIV and a fever. Furthermore, even at the time it was possible to do it, the result came too late in half of the patients. The only rational approach is causative, ie the provision of antiretroviral treatment before the immune system ahs deteriorated to a point where tubercle bacilli disseminate.