SPECTRUM OF IMMUNODEFICIENCY IN HIV-1-INFECTED PATIENTS WITH PULMONARY TUBERCULOSIS IN ZAIRE

Tuberculosis (TB) is the most common opportunistic infection in Africa n patients who die from AIDS, yet the stage of immunodeficiency at whi ch TB develops is uncertain. We studied the immune status of HIV-infec ted outpatients with pulmonary TB in relation to their clinical presen tation in a cross-sectional study of 216 HIV-seropositive and 146 HIV- seronegative ambulatory incident cases of smear-positive and culture-p ositive pulmonary TB in Kinshasa, Zaire. HIV-seropositive and seronega tive patients had median CD4 lymphocyte counts of 316.5/muL and 830.5/ muL, respectively. Of the HIV-seropositive patients, 32 9% had less th an 200 CD4 lymphocytes/muL, 37% between 200 and 499, and 30.1% 500 or more. Clinical AIDS, as defined by the WHO clinical case-definition or a modified version, was of similar limited use as a predictor of immun odeficiency. Among HIV-seropositive patients, oral candidosis, lymphop enia, a negative tuberculin purified protein derivative test, and cuta neous anergy were strongly associated with CD4 counts of less than 200 /muL, and seemed to be better markers of immune dysfunction. We conclu de that pulmonary TB develops across a broad spectrum of HIV-induced i mmunodeficiency and that a diagnosis of pulmonary TB is of limited use as a marker of stage of HIV disease in African HIV-infected outpatien ts.