Tuberculosis Pleurisy More Severe in HIV-Positive Patients

Researchers in Uganda have found that HIV-positive patients face greater risk from TB-related lung inflammations than do HIV-negative patients. H. Luzze of Uganda's National Tuberculosis Treatment Center and the Uganda-Case Western Reserve University Research Collaboration at Kampala's Mulago Hospital and colleagues conducted a study to "compare clinical and radiographic presentation, and diagnostic methods, in adults with tuberculosis pleurisy who are negative and positive for [HIV]." They found that patients coinfected with TB and HIV made up the vast majority of TB pleurisy cases, and they suffered more virulent forms of the condition than other patients.

Luzze and colleagues studied 142 patients with confirmed pleural TB, 80 percent of whom also had HIV. Coinfected patients had more severe and more persistent pleurisy, they said, with significantly lower levels of pleural fluid lymphocytes. These patients were also more likely to have positive mycobacterial pleural fluid cultures.

The researchers also observed a slightly higher rate of pleurisy with parenchymal infiltration in HIV patients, study data showed, although the discrepancy did not reach the level of significance. Serum effusions from the visceral pleura were comparable for patients regardless of their HIV status.

"HIV-positive patients with tuberculosis pleurisy had a more severe illness than HIV-negative patients," the researchers concluded. "Liquid culture media were superior to solid media with regard to diagnostic yield and time until diagnosis."

The full report, "Evaluation of Suspected Tuberculosis Pleurisy: Clinical and Diagnostic Findings in HIV-1 Positive and HIV Negative Adults in Uganda," appeared in the International Journal of Tuberculosis and Lung Diseases (2001; 5 (8): 746-753). Also on the team were researchers from Makerere University in Kampala; the Medical Research Council Program on AIDS at the Uganda Virus Research Institute in Entebbe; and the London School of Hygiene and Tropical Medicine in the United Kingdom.

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