Tuberculous lymphadenitis associated with human immunodeficiency virus (HIV) in Uganda

Abstract

Sixteen adults presented with lymphadenopathy which was tuberculous on biopsy; they were all seropositive for human immunodeficiency virus (HIV-1), but none had the clinical criteria of the acquired immunodeficiency syndrome (AIDS). The biopsy specimen showed caseating tuberculosis, with scanty or no visible acid fast bacilli in seven cases; the remaining nine had a poor cellular reactivity with numerous bacilli. Antituberculous chemotherapy for two months reduced the lymphadenopathy. Two patients subsequently developed AIDS. Mycobacterial cultures were not performed, but the infection was almost certainly Mycobacterium tuberculosis. The space-time clustering of tuberculous lymphadenitis now seen in Kampala, and the unusual non-reactive histopathology, are typical of the impairment of cellular immunity induced by HIV infection.

PIP: Tuberculosis is not among the infections currently included in the clinical case description of AIDS. However, tuberculous lymphadenitis is emerging as an increasingly common concomitant infection associated with HIV-1 seropositivity in Africa. 16 HIV-positive patients presenting at Mulago Hospital, Kampala, in 1986, with lymphadenopathy were studied. Lymph node biopsies were done on all 16, but only 7 of the histopathologic specimens showed a normal immune response to tubercle bacilli. The remaining 9 showed numerous bacilli but absent or weak cellular immune response. All patients responded to standard antituberculosis drug therapy; 2 patients developed clinical AIDS. Since HIV seropositivity seems to predispose to nontypical tuberculosis, it is recommended that in future cultures be done on tuberculous tissues from HIV-positive patients in Africa.