Reports on HIV/AIDS: 1990

MARCH 16, 1990, MMWR, Vol. 39, No. 10, pp. 153-156
Data on drug therapy were known for 14,072 (63%) of the cases reported during
1987. Medication was taken continuously during the first 6 months of therapy by 86%
of patients. Six percent interrupted their therapy; 2% stopped taking their medication;
and 9% died within the first 6 months of treatment. Approximately 75% of patients for
whom reports were available completed therapy within 12 months: 9%, within 6
months; 27%, within 7-9 months; and 39%, within 10-12 months. Approximately 11%
of patients died within 1 year of diagnosis.
More than 95,000 persons with tuberculous infection at risk for clinical disease
were reported to have begun preventive therapy during 1987; 66% completed 6
continuous months of treatment. Contacts of TB patients had a 72% completion rate.
Recent converters and other infected persons had completion rates of 70% and 64%,
respectively.
Reported by: State and local health departments. Div of Tuberculosis Control, Center for
Prevention Svcs, CDC.
Editorial Note: The number of newly reported TB patients meeting the CDC case
definition (2) represents >90% of patients under treatment supervision by state and
local health departments (CDC, unpublished data), and this percentage has remained
stable since 1984. However, the public health burden of TB is only partially reflected
by the number of new cases reported annually. In 1987, this burden included the more
than 115,000 persons under treatment for TB (>20,000 new patients plus >95,000
high-risk persons who began preventive therapy). In addition, 1755 persons died from
this curable disease.
The trends for race/ethnicity primarily reflect the increasing occurrence of TB in
persons infected with human immunodeficiency virus (HIV) (3). Because the HIVinfection status of TB patients is not collected on the TB case report form, the precise
impact of HIV infection on TB morbidity trends in the United States cannot be
determined. Nevertheless, HIV infection is an important risk factor for developing
clinically apparent TB among persons already infected with the tubercle bacillus (4).
Accordingly, CDC recommends that all HIV-infected persons be screened for TB and
latent tuberculous infection and, if infected, offered curative or preventive therapy
(5). Similarly, persons with TB and known tuberculin-positive persons should be
evaluated for HIV infection so that appropriate counseling and treatment can be
undertaken (5).
Approximately 1% of the estimated 10 million persons in the United States who are
infected with the tubercle bacillus (CDC, unpublished data) were identified and
treated in 1988. Identification and treatment of all 10 million infected persons is not
necessary to substantially reduce the burden of TB. Instead, ACET has emphasized
focusing on high-risk populations (1). The proportion of infected persons represented
in high-risk groups is unknown. However, the percentage of infected persons who are
screened and treated for TB annually must increase substantially beyond 1% if TB is
to be eliminated by the year 2010. These patients must also be carefully monitored for
compliance and adverse drug reactions (6).
Use of program performance reports allows state and local health departments to
measure their progress toward TB elimination. The reports indicate that noncompliance with prescribed therapy is the greatest remaining obstacle to elimination (7).
Ideally, 90% of patients should complete therapy within 12 months. Program and
research strategies that may be effective in addressing noncompliance include the
use of outreach workers to administer and directly observe therapy and provide
incentives to enhance compliance (8); education programs for health professionals;
studies of compliance predictors and enhancers; and research targeted toward

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