TUBERCULOUS PLEURISY IS MORE COMMON IN AIDS THAN IN NON-AIDS PATIENTSWITH TUBERCULOSIS

Objective: To investigate the incidence, clinical features, and treatm ent of tuberculous pleurisy in BIDS patients. Methods: We reviewed all cases of pleural tuberculosis in AIDS patients in South Carolina from 1988 through 1994. Clinical findings, test results, treatment, and ou tcome were analyzed. Main results: Twenty-two (11%) of the 202 AIDS pa tients with tuberculosis had pleural involvement compared to 6% (169/2 ,817) pleural involvement in non-AIDS patients (p=0.01). Associated fe atures of AIDS tuberculous pleurisy included substantial weight loss ( 7.65+/-1.35 kg) and lower lobe infiltrates (12/22; 55%). No difference in pleural fluid characteristics was found when comparing AIDS patien ts with a serum CD4 count greater than or equal to 200/mu L to patient s with CD4 count <200/mu L. Two (9%) of the 22 patients died of tuberc ulosis. Chest radiograph follow-up of 20 patients showed complete reso lution in 7, improvement in 10, and no improvement in 3. Conclusions: In South Carolina, pleural involvement is more common in AIDS patients than in non-AIDS patients with tuberculosis. Tuberculous pleurisy has several atypical features in AIDS patients such as substantial weight loss and lower lobe infiltrates. The outcome of treatment is good for most patients.