[Tuberculous peritonitis in HIV-infected patients]

Area of Science:

• Infectious Diseases
• Immunology
• Gastroenterology

Context:

• Tuberculosis peritonitis is a severe complication in Human Immunodeficiency Virus (HIV)-positive individuals.
• Understanding the clinical and laboratory features of Mycobacterium tuberculosis peritonitis in HIV+ patients is crucial for timely diagnosis and management.
• This study focuses on a cohort of HIV+ patients in Buenos Aires, Argentina, between 1996 and 2005.

Purpose:

• To describe the clinical and laboratory findings of Mycobacterium tuberculosis peritonitis in HIV-positive patients.
• To analyze factors contributing to high mortality in this patient population.

Summary:

• A retrospective analysis of 21 HIV+ patients with Mycobacterium tuberculosis peritonitis revealed a median age of 33, with 52% males.
• Common symptoms included abdominal distension (71%), fever (62%), and abdominal pain (19%). Ascitic fluid analysis showed a median leukocyte count of 751/mm³ with mononuclear predominance (79%).
• High rates of cirrhosis (65%), enolism (45%), and Hepatitis C Virus (HCV) coinfection (85%) were noted. Multidrug-resistant tuberculosis (TB-MR) was present in 20% of cases, and overall mortality reached 66.4%.

Impact:

• The high mortality rate (66.4%) underscores the severity of tuberculosis peritonitis in HIV+ patients.
• Factors contributing to mortality include a high frequency of multidrug-resistant tuberculosis (TB-MR), significant immunosuppression (median CD4 count of 85/mm³), and a high prevalence of cirrhosis.
• Inappropriate tuberculosis treatment was observed in 30% of cases, highlighting the need for accurate susceptibility testing and tailored treatment regimens.