Pleural Tuberculosis and HIV Infection

Human immunodeficiency virus infection changes the clinical presentation of tuberculosis infection with atypical radiographs and more common extrapulmonary involvement. We retrospectively studied pleural tuberculosis in HIV-positive patients over a 5-year period. We identified 70 patients with pleural tuberculosis by positive Mycobacterium tuberculosis cultures of pleural fluid and/or pleural tissue, including 43 HIV-positive and 27 HIV-negative patients. The HIV-positive patients were significantly younger (mean age, 38±1 years in HIV-positive vs 52±3 years in HIV-negative patients, p<0.05). There were more intravenous drug abusers in the HIV-positive group (74 vs 30 percent, p<0.01). The HIV-positive group had significantly fewer positive tuberculin skin tests (41 percent vs 76 percent, p<0.03). Both groups had similar pleural fluid cellularity and pleural biopsy histologic conditions, but the HIV-positive patients demonstrated significantly more acid-fast bacteria identifiable in pleural tissue (69 percent vs 21 percent, p<0.01), and a higher incidence of positive M tuberculosis cultures of sputum (53 percent vs 23 percent, p=0.02). Pleural tuberculosis in HIV-positive patients presented more often as a manifestation of a greater burden of microorganisms and impaired host response. Human immunodeficiency virus infection changes the clinical presentation of tuberculosis infection with atypical radiographs and more common extrapulmonary involvement. We retrospectively studied pleural tuberculosis in HIV-positive patients over a 5-year period. We identified 70 patients with pleural tuberculosis by positive Mycobacterium tuberculosis cultures of pleural fluid and/or pleural tissue, including 43 HIV-positive and 27 HIV-negative patients. The HIV-positive patients were significantly younger (mean age, 38±1 years in HIV-positive vs 52±3 years in HIV-negative patients, p<0.05). There were more intravenous drug abusers in the HIV-positive group (74 vs 30 percent, p<0.01). The HIV-positive group had significantly fewer positive tuberculin skin tests (41 percent vs 76 percent, p<0.03). Both groups had similar pleural fluid cellularity and pleural biopsy histologic conditions, but the HIV-positive patients demonstrated significantly more acid-fast bacteria identifiable in pleural tissue (69 percent vs 21 percent, p<0.01), and a higher incidence of positive M tuberculosis cultures of sputum (53 percent vs 23 percent, p=0.02). Pleural tuberculosis in HIV-positive patients presented more often as a manifestation of a greater burden of microorganisms and impaired host response.