EVALUATION OF TUBERCULAR PLEURAL EFFUSION IN HIV SEROPOSITIVE PATIENTS AND ITS CORRELATION TO CD4 COUNT

Aim:- To observe the characteristic of tubercular pleural effusion in HIV seropositive patients and its correlation to CD4 count. Material Method:-This study was conducted in the department of Pulmonary Medicine VSS Medical College Burla, Sambalpur , Odisha during the period of November 2014 to 2016. 44 HIV seropositive patients with pleural effusion were studied in correlation to CD4 counts. Results:-Out of 44 HIV seropositive patients with pleural effusion were studied of which 84% were males and 16% females. Maximum number of patients belonged to the age group 31-40 yrs males 16 & female 1(38.6%) followed by 21-30 yrs 25%( males 7 and females 4). Maximum number of males were in age group 31-40 whereas maximum females were in age group 21-30. Commonest occupation was driver 10 (22.7%) followed by labourers 9( 20%). Commonest constitutional symptoms were fever and generalized weakness in 26 patients (59%) and cough was the commonest respiratory symptoms in 84% of cases followed by chest pain in 63% and breathlessness in 50% of cases. Majority of effusion were Right side 22 cases(50%), Left side 15(34%) and bilateral in 7(15.9%) cases. Most of the effusions were moderate in 31(70.4%) cases, minimal in 9(20%) and massive in 4(9%).Pleural fluid was straw coloured in 39 cases(89%) and haemorrhagic in 5(11%) cases.Maximum patients (23 ie 52.3%) were having CD4 count in range of 201-500, followed by 11 cases in range of 101-200. 2 patients were having CD4 count >500/cumm and 4 below <50/cumm.ADA level was >100 in 1 case ,<40 in 1 (2.27%), >60 in 23 (52%) and between 40 to 60 in 19 cases(43.18%).Out of 44 patients, 39 showed predominantly lymphocytic pattern, 5 cases showed neutrophilic pattern. In 5 cases, RBCs were also found in pleural fluid.Out of total 44 cases, number of patients having pleural fluid positive for AFB was 6 ie 13.6% of cases. Pleural fluid for AFB was positive at lowest CD4 count of 48 and highest at CD4 count of 304/cumm.Corrected Chi-square test showed that there was significant association between CD4 RANGE and TUBERCULIN TEST (p=0.12).Corrected Chi-square test showed that there was no significant association between CD4 RANGE and radiological findings (p=0.68). Conclusion:- Tuberculosis is one of the most common opportunistic infection associated with HIV irrespective of CD4 status. So, high degree of clinical suspicion, early and rapid diagnostic methods like CB NAAT MTB/RIF and appropriate antitubercular therapy should be instituted to improve quality of life.