A systematic review of the epidemiology, immunopathogenesis, diagnosis, and treatment of pleural TB in HIV-infected patients

Clin Dev Immunol. 2012;2012:842045. doi: 10.1155/2012/842045. Epub 2012 Mar 14.


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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adenosine Deaminase / blood
  • Adenosine Deaminase / immunology
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / therapeutic use
  • Antitubercular Agents / administration & dosage
  • Antitubercular Agents / therapeutic use
  • Bacterial Load
  • Biomarkers / blood
  • CD4 Lymphocyte Count
  • Coinfection
  • HIV Infections* / drug therapy
  • HIV Infections* / immunology
  • HIV-1*
  • Humans
  • Interferon-gamma / blood
  • Interferon-gamma / immunology
  • Mycobacterium tuberculosis
  • Tuberculosis, Pleural* / diagnosis
  • Tuberculosis, Pleural* / drug therapy
  • Tuberculosis, Pleural* / epidemiology
  • Tuberculosis, Pleural* / immunology
  • Viral Load


  • Anti-HIV Agents
  • Antitubercular Agents
  • Biomarkers
  • Interferon-gamma
  • Adenosine Deaminase