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.