Pleural tuberculosis in patients infected with HIV in Addis Ababa

Objective: To determine the prevalence of HIV-1 infection in patients with pleural tuberculosis and compare the clinical and radiological characteristics, effects and side effects of drugs, compliance to treatment and outcome by HIV status. Design: A hospital based, prospective study. Subjects: 90 adult patients with pleural tuberculosis. 120 surgical patients admitted for non-HIV related conditions served as controls. Setting: Black Lion Hospital, a tertiary care referral hospital in Addis Ababa, Ethiopia. Results: 22% of the patients with pleural tuberculosis versus 6.7% for the controls (p<0.01) were seropositive for HIV-1. Amongst patients with pleural tuberculosis, HIV seropositive patients were more likely to be male, and had longer duration of illness prior to coming to hospital (p<0.05). They had more disseminated disease (p<0.01), bilateral pleural effusion (p<0.05), adverse reaction to anti-tuberculosis drugs (p<0.05) and increased mortality (p<0.05). Hepatitis was the most common side effect observed. There was no difference in size of the effusion, clinical improvement, radiographic resolution or defaulter rate. Conclusion: HIV associated pleural tuberculosis commonly occurs with other forms of extra pulmonary tuberculosis and responds well to treatment Hepatitis is a frequent side effect and entails poor prognosis. We therefore recommend careful documentation of a previous history of liver disease and baseline investigation of liver function tests before initiation of treatment. The finding of bilateral pleural effusion may indicate the presence of underlying HIV infection.