I write in response to the comprehensive article by Chanda and Gosnell (2006) in which they described in great detail the tuberculosis situation in Zambia, especially among nurses. I am wondering what, if any, role HIV infection among nurses might be contributing to this expanding epidemic of tuberculosis which the authors have observed. Secondly, as the authors have also reported small, but I think critical, reductions in proportions of nurses with active tuberculosis, I am also inclined to speculate as to whether the availability of HIV antiretroviral therapy may be changing this epidemic among nurses. Some insights into these issues may have important policy implications, such as whether it would be appropriate to deploy HIV-infected nurses to situations where they may be exposed to infectious agents which their immune system may fail to deal with appropriately.
Adamson S. Muula, MPH, MB, BS, Diploma in Palliative Care
Department of Community Health, University of Malawi, College of Medicine
Department of Epidemiology, University of North Carolina at Chapel Hill