C. Richter et al., CLINICAL-FEATURES OF HIV-SEROPOSITIVE AND HIV-SERONEGATIVE PATIENTS WITH TUBERCULOUS PLEURAL EFFUSION IN DAR-ES-SALAAM, TANZANIA, Chest, 106(5), 1994, pp. 1471-1475
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.