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Pleural tuberculosis in patients infected with HIV in Addis Ababa
A G Aderaye1, B K Melaku, C G Zenebe
1Department of Internal Medicine, Faculty of Medicine, Addis Ababa University, Ethiopia.
Objective:
To determine the prevalence of HIV-1 infection in patients with pleural tuberculosis and compare the clinical and radiological characteristics, effects and side effects of drugs, compliance to treatment and outcome by HIV status.
Design:
A hospital based, prospective study.
Subjects:
90 adult patients with pleural tuberculosis. 120 surgical patients admitted for non-HIV related conditions served as controls.
Setting:
Black Lion Hospital, a tertiary care referral hospital in Addis Ababa, Ethiopia.
Results:
22% of the patients with pleural tuberculosis versus 6.7% for the controls (p < 0.01) were seropositive for HIV-1. Amongst patients with pleural tuberculosis, HIV seropositive patients were more likely to be male, and had longer duration of illness prior to coming to hospital (p < 0.05). They had more disseminated disease (p < 0.01), bilateral pleural effusion (p < 0.05), adverse reaction to anti-tuberculosis drugs (p < 0.05) and increased mortality (p < 0.05). Hepatitis was the most common side effect observed. There was no difference in size of the effusion, clinical improvement, radiographic resolution or defaulter rate.
Conclusion:
HIV associated pleural tuberculosis commonly occurs with other forms of extra pulmonary tuberculosis and responds well to treatment. Hepatitis is a frequent side effect and entails poor prognosis. We therefore recommend careful documentation of a previous history of liver disease and baseline investigation of liver function tests before initiation of treatment. The finding of bilateral pleural effusion may indicate the presence of underlying HIV infection.