title: A systematic review of the epidemiology, immunopathogenesis, diagnosis, and treatment of pleural TB in HIV-infected patients.
abstract: BACKGROUND
  High HIV burden countries have experienced a high burden of pleural TB in HIV-infected patients.
  
  
  OBJECTIVE
  To review the epidemiology, immunopathogenesis, diagnosis, and treatment of pleural TB in HIV-infected patients.
  
  
  METHODS
  A literature search from 1950 to June 2011 in MEDLINE was conducted.
  
  
  RESULTS
  Two-hundred and ninety-nine studies were identified, of which 30 met the inclusion criteria. The immunopathogenesis as denoted by cells and cytokine profiles is distinctly different between HIV and HIV-uninfected pleural TB disease. Adenosine deaminase and interferon gamma are good markers of pleural TB disease even in HIV-infected patients. HIV-uninfected TB suspects with pleural effusions commonly have a low yield of TB organisms however the evidence suggests that in dually infected patients smear and cultures have a higher yield. The Gene Xpert MTB/RIF assay has significant potential to improve the diagnosis of pleural TB in HIV-positive patients.
  
  
  CONCLUSIONS
  Pleural TB in HIV-infected patients has a different immunopathogenesis than HIV-uninfected pleural TB and these findings in part support the differences noted in this systematic review. Research should focus on developing an interferon gamma-based point of care diagnostic test and expansion of the role of Gene Xpert in the diagnosis of pleural TB.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Aljohaney
authors.forename: K
authors.initials: K
authors.lastname: Amjadi
authors.forename: G G
authors.initials: GG
authors.lastname: Alvarez
mesh_terms: D000243:Adenosine Deaminase / Q000097:blood / Q000276:immunology; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D058491:Bacterial Load; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1; D006801:Humans; D007371:Interferon-gamma / Q000097:blood / Q000276:immunology; D009169:Mycobacterium tuberculosis; D014396:Tuberculosis, Pleural / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D015415:Biomarkers; D007371:Interferon-gamma; D000243:Adenosine Deaminase