Tuberculosis as a Manifestation of the Acquired Immunodeficiency Syndrome

To the Editor.—  The frequency of diagnosed Mycobacterium tuberculosis infection in the acquired immunodeficiency syndrome (AIDS) is escalating. The recent article by Sunderam et al¹ raises interesting issues regarding the relationship of these two diseases. Mycobacterium tuberculosis infection was shown in their study to have severe and unusual manifestations, with overwhelming extrapulmonary disease. The lack of an intact T-cell immune response in AIDS has been the commonly accepted explanation.¹ However, the enhanced suppressor cell activity common to both infections may play a role in the pathogenesis of these simultaneously occurring diseases.T-cell lymphopenia with a decrease in the T-helper/suppressor cell ratio occurs in untreated patients with M tuberculosis infection and can be reversed with therapy.² Patients with M tuberculosis infection who demonstrate cutaneous anergy have enhanced suppressor cell activity. In vitro, once suppressor cells are depleted, there is a 24-fold increase in T-lymphocyte response to purified protein