HIV infection among tuberculous patients in Morocco.

Referring to the report (Eur Respir J, 1991; 4: 1288-1295): "Tuberculosis elimination in the countries of Europe and other industrialized countries", we should like to add our experience in screening for human immunodeficiency virus (HIV)-infection among tuberculosis patients. In Morocco, a high incidence of tuberculosis (105 per 100,000) is associated with a low prevalence of HIV infection (1, 2, 3, 4). Therefore, the evaluation of HIV infections in tuberculosis patients appears to be relevant. From 14 March, 1988 to 27 May, 1990 a sample of 997 adult patients suffering from bacteriologically confirmed tuberculosis and admitted to the University Hospital of Casablanca, agreed to be screened for HIV-1 and HIV-2 antibodies. Three of them (0.3%) were found to be HIV-1 seropositive, whereas no HIV-2 seropositive case was detected. This number is lower than HIV prevalence among tuberculosis cases of other African countries, where HIV infection represents a great public health problem and where the rate can reach 60% [5). Our figure is, however, clearly higher than the degree of HIV seropositivity (0.21 per 1,000) among a sample of 143,802 blood donors screened in Morocco during the same period (4). We do not know whether the tuberculosis cases found in our sample are attributable to HIV infection. We could only infer that HIV-associated tuberculosis is not yet a major public health problem in Casablanca. However, we consider that tuberculosis patients could constitute a valuable sentinel group for an HIV national survey, because Human Immunodeficiency Virus infection has emerged as the strongest risk factor for the progression of latent tuberculosis infection to disease [6]. Even in developed countries such as the USA a high prevalence of dual infection has resulted in a high rate of AIDS cases with tuberculosis (7]. The situation in Europe should be carefully monitored.