CLINICAL-FEATURES OF TUBERCULOSIS ASSOCIATED WITH HIV-INFECTION IN TAIWAN

To understand the clinical characteristics and outcome of tuberculosis (TB) in patients with acquired immunodeficiency syndrome (AIDS) in Ta iwan, we reviewed the medical records of 118 adult AIDS patients who w ere hospitalized at National Taiwan University Hospital between Januar y 1988 and September 1995. Among them, 29 (24.6%) had TB. The mean age of the AIDS patients with TB was 37 years (range, 25-66 yr). Most pat ients were in the advanced stages of AIDS when human immunodeficiency virus (HIV) infection and/or TB were first diagnosed. The mean CD4+ ly mphocyte count was 0.037 x 10(9)/L (range, 0-0.152 x 10(9)/L) at the t ime TB was diagnosed. There was no statistically significant differenc e in the mean CD4+ lymphocyte count between patients with isolated pul monary TB and those with extrapulmonary involvement. Twenty-two patien ts (75.8%) had extrapulmonary TB with the most common site being the l ymph nodes (72.7%). Clinical symptoms were nonspecific, and the chest physical examination was not helpful in the diagnosis. Acid-fast bacil li were detected in sputum smears from eight patients (36.4%). A prima ry tuberculosis pattern (hilar adenopathy, pleural effusion, middle or lower lobe infiltrates) in the chest radiographs was the most common radiologic finding (36.4%) in patients with pulmonary TB. The reactiva tion pattern (predominant upper-lobe infiltrates with or without cavit ation) could only be found in cases of pulmonary TB without extrapulmo nary involvement. Atypical patterns (diffuse interstitial infiltrates mimicking Pneumocystis carinii pneumonia or other patterns) and normal chest radiographs were noted in nearly one-third of the patients with pulmonary TB. A good response to antituberculosis drugs and a favorab le outcome were demonstrated in the patients, except for two with drug -resistant Mycobacterium tuberculosis infection. Early identification of TB in HIV-infected patients requires clinical awareness of the unus ual clinical presentations, especially among patients in the advanced stages of AIDS.