Reporting of co-infection still limited

Less than 50% of TB case reports give HIV info

The number of new TB cases in this country last year dropped 7% from the previous year - 19,855 in 1997 compared to 21,327 in 1996 - but health officials still have less information than they would like about where HIV and TB are intersecting.

With five years of declines in TB cases under its belt, health officials from the Centers for Disease Control and Prevention are confident that the TB epidemic that reached a peak in the late 1980s has been thwarted by increased funding, tighter controls, and improved diagnosis and treatment.

Nonetheless, recent success is tempered by the heavy toll of TB disease burden in this country that originates in people born outside the country. Nearly 40% of U.S. cases of TB are now among people born outside the country, primarily from Southeast Asia, Africa, and Latin America.

"In the United States it may be tempting to rest easy because we appear to have TB under control," says Helene Gayle, MD, MPH, director of the CDC's National Center for HIV, STD, and TB Prevention. "Yet even in this country we continue to identify cases of multidrug-resistant TB. There is no question that the continued spread of MDR-TB internationally could dramatically impact the United States."

Outbreaks of MDR-TB, particularly among HIV-infected people, played a large role in the resurgence of TB in the late 1980s and early 1990s. Health officials have tried to estimate how many HIV-positive patients are also infected with TB in this country. The most recent matching of AIDS and TB registries has shown that 14% of all TB cases (27% of those cases in people aged 25-44 years) were also reported with an AIDS diagnosis.

Knowing that the impact of HIV on TB infection varies by geography, the CDC began requesting in 1993 that health care departments include HIV information on TB case reports so it can better monitor the epidemics. Yet reporting remains incomplete. In 1997, only 3,485 cases, or 50% of the 6,915 TB cases reports of people aged 35-44 years, included information about HIV status.

Moreover, only 15 states reported HIV test results for at least 75% of cases in people in that age group, the CDC notes. The percentage of TB patients co-infected with HIV in those 15 states ranged from zero in North Dakota and South Dakota to 48% in Florida.