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December 12, 1986

Tuberculosis as a Manifestation of the Acquired Immunodeficiency Syndrome-Reply

Author Affiliations

University of Medicine and Dentistry of New Jersey Newark

JAMA. 1986;256(22):3093. doi:10.1001/jama.1986.03380220058014

In Reply.—  I appreciate the comments of Guarner et al. More investigators are noting serious M tuberculosis disease in persons infected with HIV with risk factors other than intravenous drug abuse. In addition to Guarner et al, Schecter et al1 have also reported this, and I am aware of similar data in press. As my coauthors and I suggested, "AIDS reflects and magnifies diseases that are endemic to a particular locality." Atlanta was third in the nation in tuberculosis case rate in 1984,2 and Guarner et al describe the population served by Grady Memorial Hospital as being an "inner-city, low socioeconomic status, predominantly black" one. Reichman et al3 showed in 1979 (before the AIDS epidemic) that intravenous drug abuse was a risk factor for tuberculosis beyond race and socioeconomic status; this was confirmed in our series of patients with AIDS, who were from a population of intravenous