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Pleural tuberculosis and HIV infection

F Relkin1, C P Aranda, S M Garay

  • 1Bellevue Hospital, Department of Medicine, New York.

Chest
|May 1, 1994
PubMed
Summary

Human immunodeficiency virus (HIV) infection alters tuberculosis presentation, often leading to more extrapulmonary disease. HIV-positive patients with pleural tuberculosis showed increased bacterial burden and impaired immune response.

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Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Immunology

Background:

  • Human immunodeficiency virus (HIV) infection significantly impacts the clinical presentation of tuberculosis (TB).
  • HIV infection is associated with atypical radiographic findings and increased extrapulmonary TB involvement.
  • Pleural tuberculosis (PTB) is a common manifestation of TB, particularly in HIV-positive individuals.

Purpose of the Study:

  • To compare the clinical and microbiological characteristics of pleural tuberculosis in HIV-positive versus HIV-negative patients.
  • To elucidate the role of HIV in the presentation and diagnosis of PTB.
  • To understand the host response in HIV-associated PTB.

Main Methods:

  • Retrospective study of 70 patients diagnosed with PTB via Mycobacterium tuberculosis cultures over a 5-year period.

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  • Patient groups were stratified based on HIV status (43 HIV-positive, 27 HIV-negative).
  • Data collected included age, risk factors (intravenous drug use), tuberculin skin test results, pleural fluid analysis, pleural biopsy histology, and sputum/tissue M. tuberculosis cultures.

    • Main Results:

    • HIV-positive patients were significantly younger and had a higher prevalence of intravenous drug use.
    • Tuberculin skin tests were less frequently positive in HIV-positive individuals (41% vs. 76%).
    • HIV-positive patients showed significantly more acid-fast bacilli in pleural tissue (69% vs. 21%) and higher rates of positive sputum M. tuberculosis cultures (53% vs. 23%).

    Conclusions:

    • Pleural tuberculosis in HIV-positive patients is characterized by a greater burden of microorganisms and an impaired host immune response.
    • Diagnostic indicators like tuberculin skin tests may be less reliable in HIV-positive individuals with PTB.
    • HIV significantly influences the presentation and microbiological findings in pleural tuberculosis.