Comparative histopathological study of pulmonary tuberculosis in human immunodeficiency virus-infected and non-infected patients

Tuber Lung Dis. 1996 Jun;77(3):244-9. doi: 10.1016/s0962-8479(96)90008-8.


Setting: 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.

Design: 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.

Conclusion: 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.

Publication types

  • Comparative Study

MeSH terms

  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / microbiology
  • AIDS-Related Opportunistic Infections / pathology*
  • Adult
  • Bronchoscopy
  • CD4 Lymphocyte Count
  • Female
  • Humans
  • Male
  • Mycobacterium tuberculosis / isolation & purification
  • Retrospective Studies
  • Tuberculin Test
  • Tuberculosis, Pulmonary / immunology
  • Tuberculosis, Pulmonary / microbiology
  • Tuberculosis, Pulmonary / pathology*