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.