Aspects of tuberculosis in Africa. 1. Tuberculosis in Africa in the AIDS era--the role of chemoprophylaxis.

An estimated 2.8 million people in Africa have dual infections with tuberculosis and human immunodeficiency virus (HIV). Because of the increasing numbers of cases of tuberculosis as a consequence of the HIV epidemic, chemoprophylaxis may become a cost effective tuberculosis control measure in high prevalence countries. Although isoniazid (INH) is the only drug evaluated in controlled trials of preventive tuberculosis therapy, studies are now under way to determine the efficacy of INH and other drugs, including rifampicin and pyrazinamide, in preventing tuberculosis reactivation in persons with HIV infection. If chemoprophylaxis is effective in persons with dual infection, further studies will be required to determine whether chemoprophylaxis is cost effective for tuberculosis prevention and control and whether it is feasible to introduce it as a community control measure.