CLINICAL-FEATURES OF HIV-SEROPOSITIVE AND HIV-SERONEGATIVE PATIENTS WITH TUBERCULOUS PLEURAL EFFUSION IN DAR-ES-SALAAM, TANZANIA

In a prospective study, we investigated whether human immunodeficiency virus (HIV) infection alters the clinical presentation in patients wi th tuberculous pleuritis. One hundred twelve of 118 patients who prese nted with pleural effusion suffered from tuberculosis (TB); 65 patient s (58%) were HIV seropositive. Evidence of disseminated TB was found m ore often in HIV-positive than in HIV-negative patients (30.8% vs 10.6 %, p<0.02). Dyspnea, fever, night sweat, fatigue, and diarrhea, severe tachypnea, hepatomegaly, splenomegaly, and lymphadenopathy were signi ficantly more common in HIV-infected than in HIV-negative patients wit h TB. The same applied to a negative Mantoux reaction, lower hemoglobi n, higher beta(2)-microglobulin values, and in pleural fluid, lower al bumin and higher gamma-globulin levels. Among HIV-infected patients, P PD skin test anergy was significantly associated with relative low alb umin and gamma-globulin levels of pleural fluid. However, the radiogra phic features did not differ with respect to HIV status; they were pre dominantly those of primary pleuritis (78% in each group). We conclude that coexisting HIV infection affects clinical and laboratory feature s, but not the radiographic presentation of patients with TB pleuritis in Tanzania.