title: Pleural tuberculosis in Harare, Zimbabwe: the relationship between human immunodeficiency virus, CD4 lymphocyte count, granuloma formation and disseminated disease.
abstract: OBJECTIVE
  To elucidate the relationship between HIV, CD4+ count and pleural TB.
  
  
  METHODS
  In a prospective study, 94 patients presenting at two large Harare hospitals with clinically suspected pleural TB were enrolled over a 10-month period. All underwent standardized evaluation, closed pleural aspiration and biopsy. Patients receiving directly observed anti-TB therapy were followed-up.
  
  
  RESULTS
  Pleural TB was diagnosed in 90 individuals (median age 33 years; range 18-65; 64 males); the seroprevalence of HIV was 85%. HIV-positive patients were older than HIV-negative individuals (median age 33 vs 23 years, P = 0.013) and had a significantly lower median CD4+ count (191 vs 1106 x 10(6)/l respectively, P = 0.004). A CD4+ count of <200 x 10(6)/l was associated with a length of illness >30 days (65% vs 37%; P = 0.05), a positive pleural fluid smear (37% vs 0%; P = 0.0006) and a positive pleural biopsy Ziehl-Neelsen stain (35% vs 7%; P = 0.021). However, a relationship between CD4+ count and either pleural granuloma formation or radiological evidence of disseminated disease was not observed.
  
  
  CONCLUSIONS
  In sub-Saharan Africa, TB pleural effusions have become associated with older age, a chronic onset, and an increased mycobacterial load. These data emphasize the complex relationship between pleural TB, HIV infection and a low CD4+ count.
authors.affiliation: Department of Medicine, Medical School, University of Zimbabwe.
authors.forename: R S
authors.initials: RS
authors.lastname: Heyderman
authors.forename: R
authors.initials: R
authors.lastname: Makunike
authors.forename: T
authors.initials: T
authors.lastname: Muza
authors.forename: M
authors.initials: M
authors.lastname: Odwee
authors.forename: G
authors.initials: G
authors.lastname: Kadzirange
authors.forename: J
authors.initials: J
authors.lastname: Manyemba
authors.forename: C
authors.initials: C
authors.lastname: Muchedzi
authors.forename: B
authors.initials: B
authors.lastname: Ndemera
authors.forename: Z A
authors.initials: ZA
authors.lastname: Gomo
authors.forename: L K
authors.initials: LK
authors.lastname: Gwanzura
authors.forename: P R
authors.initials: PR
authors.lastname: Mason
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D005260:Female; D006099:Granuloma / Q000150:complications* / Q000276:immunology / Q000473:pathology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000473:pathology; D011446:Prospective Studies; D014396:Tuberculosis, Pleural / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D015030:Zimbabwe / Q000453:epidemiology