PLEURAL TUBERCULOSIS AND HUMAN-IMMUNODEFICIENCY-VIRUS COINFECTION

SETTING: Department of internal medicine in a general hospital in Rio de Janeiro, Brazil, which provides secondary care to the poor populati on. OBJECTIVE: The aim of this study was to evaluate the prevalence of human immunodeficiency virus (HIV) infection in patients with pleural tuberculosis (TB) and to compare its manifestations in HIV-negative a nd HIV-infected patients. DESIGN: Cross-sectional study. METHODS: Fort y-three patients with a final diagnosis of pleural TB were submitted t o HIV testing (ELISA), chest X-ray, and thoracentesis for biochemical, cytological, and bacteriological analysis. Pleural tissue was obtaine d in 36 patients for histopathological examination. PPD testing was pe rformed in 29 patients. Whenever productive cough was present, sputum acid-fast smears and culture for Mycobacterium tuberculosis were perfo rmed. RESULTS: The HIV prevalence was high (30%). TB symptoms were sim ilar in both groups. Atypical radiological aspects were observed in HI V-infected patients with concurrent pulmonary TB (P = 0.03). Pleural f luid, tissue aspects and PPD testing were comparable in both groups. C ONCLUSION: Only atypical radiographic patterns in patients with concur rent pulmonary TB were indicative of HIV infection. Therefore, a high index of suspicion is necessary for the early recognition of HIV/TB co infection. We suggest that all patients presenting with pleural TB sho uld be screened for anti-HIV antibodies.