Influence of HIV status on pathological changes in tuberculous pleuritis.

SETTING

The AIDS epidemic has been associated with an increase in the incidence of tuberculosis, pulmonary or extrapulmonary.

OBJECTIVE

To compare morphological changes in tuberculous pleurisy, and response to therapy in HIV-positive and-negative patients.

DESIGN

57 consecutive patients admitted between January and August 1991 with tuberculous pleurisy who were biopsy proven were studied. 36 were HIV-positive and 21 were HIV-negative.

RESULTS

3 types of morphological changes were observed: reactive, hyporeactive and non-reactive. Hypo- and non-reactive patterns were found in 14 of 36 HIV-positive patients but in only 2 of 21 HIV-negative patients (P < 0.02). In the HIV-positive group, 10 of the 14 with hypo- or non-reactive patterns had other HIV-related complications, compared to 6 of 22 with reactive patterns (P < 0.01). When HIV-positive patients' response to therapy was investigated, 2 of 5 patients with hypo- and non-reactive patterns improved compared to all 13 with reactive patterns (P < 0.05).

CONCLUSION

A hypo- or non-reactive tissue reaction in HIV-positive patients with tuberculous pleuritis seems to indicate a less favourable prognosis.