PLEURAL TUBERCULOSIS AND HIV-INFECTION

Human immunodeficiency virus infection changes the clinical presentati on of tuberculosis infection with atypical radiographs and more common extrapulmonary involvement. We retrospectively studied pleural tuberc ulosis in HIV-positive patients over a 5-year period. We identified 70 patients with pleural tuberculosis by positive Mycobacterium tubercul osis cultures of pleural fluid and/or pleural tissue, including 43 HIV -positive and 27 HIV-negative patients. The HIV-positive patients were significantly younger (mean age, 38+/-1 years in HIV-positive vs 52+/ -3 years in HIV-negative patients, p<0.05). There were more intravenou s drug abusers in the HIV-positive group (74 vs 30 percent, p<0.01). T he HIV-positive group had significantly fewer positive tuberculin skin tests (41 percent vs 76 percent, p<0.03). Both groups had similar ple ural fluid cellularity and pleural biopsy histologic conditions, but t he HIV-positive patients demonstrated significantly more acid-fast bac teria identifiable in pleural tissue (69 percent vs 21 percent, p<0.01 ), and a higher incidence of positive M tuberculosis cultures of sputu m (53 percent vs 23 percent, p=0.02). Pleural tuberculosis in HIV-posi tive patients presented more often as a manifestation of a greater bur den of microorganisms and impaired host response.