Citing a dramatic increase in tuberculosis cases that many believe is linked to the AIDS epidemic, state health officials Thursday made infection with the AIDS virus a reportable disease for patients also infected with tuberculosis. The new requirement announced by Health Services Commissioner Susan S. Addiss marks the first time Connecticut has made it mandatory to report any form of infection with HIV, the virus that causes auired immune deficiency syndrome.
Tuberculosis is believed to pose a particular threat to HIV-infected people because of their impaired immune systems.
Health officials said that the reporting of the combination would help them intervene in cases to make sure TB-infected patients take medications that not only prevent the onset of tuberculosis, but protect others from catching the disease. Unlike AIDS, tuberculosis can be spread by a cough or a sneeze.
AIDS-rights groups criticized the step. They said it was unnecessary and would scare people away from being tested for HIV and seeking treatment.
Doctors already are required to notify health officials any time they make a diagnosis that someone is suffering from tuberculosis, an illness that usually appears in the lungs, but is now readily controllable with medication.
There has been no requirement, however, for reporting infection with tuberculosis because so few people actually become ill. As many as 10 million Americans -- 200,000 people in Connecticut, Addiss said -- have been exposed to the tuberculosis bacillus. But most will never get the disease because their immune systems hold it in check. The elderly, however, are at greater risk.
With Gov. Lowell P. Weicker Jr. looking on during a press conference at the state Capitol, Addiss called tuberculosis "an old health-care enemy [that] has returned to haunt us."
Those most likely to benefit from the new policy, she said, are "the homeless, the urban poor and the health professionals who care for them." Health officials said there is a problem with TB-infected people who do not follow doctors' instructions to take their pills, creating a need for health officials to monitor their
Tuberculosis, which conjures up images of a bygone era of sanitariums and quarantines, had dimmed in the public eye as a major health threat until a few years ago. Nationally, cases declined from 83,304 in 1953 to 22,255 in 1984, a drop sped along by the invention of TB-fighting drugs.
Since 1985, however, tuberculosis cases in the nation have edged upward 3 percent to 6 percent a year -- and in Connecticut they have increased more than twice as fast. According to the U.S. Centers for Disease Control, Connecticut in the first six months of this year recorded 91 cases, a 21 percent increase over the comparable figure a year ago.
The most likely reason, health officials say, is the AIDS epidemic. People whose immune systems have been hobbled by HIV are especially prone to the mycobacteria that invade the lungs and other organs to cause tuberculosis. A 1988 study found that the incidence of tuberculosis in patients with AIDS was 500 times as high as in the general population.
Also, some HIV-infected people have died prematurely from treatable tuberculosis that their doctors failed to diagnose. A study last year showed that nearly half of those at one medical center died of tuberculosis that went undiagnosed or was diagnosed too late.
If they are started before the disease appears and are taken for at least a year, drugs such as isoniazid can keep tuberculosis from ever appearing.
After Thursday's action in Connecticut, only six states and the District of Columbia have no requirement whatsoever that doctors and AIDS-testing centers report individuals who test positive for HIV, according to the AIDS Policy Center of the Intergovernmental Health Policy Project at George Washington University.
Carisa Cunningham, a spokeswoman for the AIDS Action Council, a Washington lobbying group, said Connecticut's action would "create a disincentive to be tested." Right or wrong, she said, people at risk of AIDS are afraid of having their name kept on file in state offices.
But Dr. Dixie E. Snider Jr., who heads the U.S. disease centers' tuberculosis-control division, said combined reporting offers crucial information to doctors, who must treat tuberculosis differently in HIV-infected patients. And, he said, it benefits public health authorities who do not yet have reliable data on how strong the link is between AIDS and the increase in tuberculosis cases.
Addiss said that the information collected will be kept confidential, as are all reported communicable diseases. Personal information collected by the state is not shared with insurance companies, she said.