Rs. Heyderman et al., PLEURAL TUBERCULOSIS IN HARARE, ZIMBABWE - THE RELATIONSHIP BETWEEN HUMAN-IMMUNODEFICIENCY-VIRUS, CD4 LYMPHOCYTE COUNT, GRANULOMA-FORMATIONAND DISSEMINATED DISEASE, TM & IH. Tropical medicine & international health, 3(1), 1998, pp. 14-20
OBJECTIVE To elucidate the relationship between HIV, CD4(+) count and
pleural TB. METHOD In a prospective study, 94 patients presenting at t
wo large Harare hospitals with clinically suspected pleural TB were en
rolled over a 10-month period. All underwent standardized evaluation,
closed pleural aspiration and biopsy. Patients receiving directly obse
rved anti-TB therapy were followed-up. RESULTS Pleural TB was diagnose
d in 90 individuals (median age 33 years; range 18-65; 64 males); the
seroprevalence of HIV was 85%. HIV-positive patients were older than H
IV-negative individuals (median age 33 vs 23 years, P = 0.013) and had
a significantly lower median CD4(+) count (191 vs 1106 x 10(6)/1 resp
ectively, P = 0.004). A CD4(+) count of <200 x 10(6)/1 was associated
with a length of illness >30 days (65% vs 37%; P = 0.05), a positive p
leural fluid smear (37% vs 0%; P = 0.0006) and a positive pleural biop
sy Ziehl-Neelsen stain (35% vs 7%; P = 0.021). However, a relationship
between CD4(+) count and either pleural granuloma formation or radiol
ogical evidence of disseminated disease was not observed. CONCLUSION I
n sub-Saharan Africa, TB pleural effusions have become associated with
older age, a chronic onset, and an increased mycobacterial load. Thes
e data emphasize the complex relationship between pleural TB, HIV infe
ction and a low CD4(+) count.