Tuberculosis has not been well documented as a complication of the acquired immunodeficiency syndrome (AIDS). We studied 48 cases of mycobacterial diseases among a group of 136 adult patients with AIDS over a 43-month period. Twenty-nine of them had severe and unusual manifestations of disease due to Mycobacterium tuberculosis, predominantly extrapulmonary and disseminated. Tuberculosis was more common among Haitians (4/8) and intravenous drug abusers (24/102) than among homosexuals who did not abuse drugs (0/22). Twelve of 21 patients with tuberculosis who were treated responded well, whereas three developed progressive disease indicative of treatment failure. Severe and unusual presentation of overwhelming tuberculosis in appropriate clinical circumstances may be considered an infection predictive of the presence of AIDS.

Twenty-one patients with long histories of failed treatment for pulmonary tuberculosis, most of whom were recalcitrant in taking medications, were treated on a primarily ambulatory basis with various antituberculosis drugs. Supervision ensured that medication was taken. Convenient, personalized, comprehensive medical care and social services were provided without cost to patients during the early phase of treatment. Management during the continuation phase was unsupervised. Fourteen patients had drug-resistant tuberculosis and 16 were either alcohol or opiate abusers. Treatment success was achieved in 19 of 21 patients with a mean follow-up of 26 months. Two patients failed to achieve a sputum-negative status for Mycobacterium tuberculosis.

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Before the disease can be treated, it must be recognized. Tuberculosis should be considered a diagnostic possibility when spinal osteomyelitis is seen, even in the absence of pulmonary disease or HIV infection. Back pain in a patient with tuberculosis should be evaluated. Early initiation of an appropriate treatment regimen may reduce the need for surgical intervention, but most patients require surgery.