Comparative histopathological study of pulmonary tuberculosis in human immunodeficiency virus-infected and non-infected patients.
METHODS
Clinical features of human immunodeficiency virus (HIV)-associated tuberculosis depend upon the patients' residual immunity. An immune-dependent presentation has also been described at the histopathological level in many extra-pulmonary sites, but no descriptions have so far been made on the histopathology of HIV-associated pulmonary tuberculosis.


OBJECTIVE
To compare the histopathological features of pulmonary tuberculosis in HIV-infected subjects and seronegative patients.


METHODS
We carried out a retrospective comparative study on 16 HIV-infected subjects and 16 seronegative patients with culture-proven pulmonary tuberculosis who underwent transbronchial biopsy. We evaluated the bacillary burden and the parenchymal inflammatory reaction by means of a four-graded scoring system giving an approximate quantitative measure of the two parameters.


RESULTS
HIV-associated pulmonary tuberculosis was found to differ significantly from disease forms seen in seronegative patients, with a significant tendency to develop highly bacillary and poorly reactive histopathological pictures along with the downgrading evolution of immune function.


CONCLUSIONS
Pathologic features of pulmonary tuberculosis in HIV-infected subjects differ from those encountered in seronegative patients depending upon the individual immunity of the former. HIV-associated progressive depletion of CD4+ lymphocytes leads to substantial changes in pulmonary reactivity to Mycobacterium tuberculosis; multibacillary pictures in a background of loose inflammatory reactions are quite common findings at the extreme phase of HIV-related immune deterioration.
Di Perri
G
G
Institute of Immunology and Infectious Diseases, University of Verona, Italy.
Cazzadori
A
A
Vento
S
S
Bonora
S
S
Malena
M
M
Bontempini
L
L
Lanzafame
M
M
Allegranzi
B
B
Concia
E
E
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000382:microbiology / Q000473:pathology*; D000328:Adult; D001999:Bronchoscopy; D018791:CD4 Lymphocyte Count; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012189:Retrospective Studies; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000276:immunology / Q000382:microbiology / Q000473:pathology*