Aljohaney A, Amjadi K, Alvarez G G
Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
Clin Dev Immunol. 2012;2012:842045. doi: 10.1155/2012/842045. Epub 2012 Mar 14.
High HIV burden countries have experienced a high burden of pleural TB in HIV-infected patients.
To review the epidemiology, immunopathogenesis, diagnosis, and treatment of pleural TB in HIV-infected patients.
A literature search from 1950 to June 2011 in MEDLINE was conducted.
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.
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.
高负担艾滋病病毒（HIV）国家的HIV感染患者中，胸膜结核负担较重。
综述HIV感染患者胸膜结核的流行病学、免疫发病机制、诊断及治疗。
检索1950年至2011年6月MEDLINE数据库中的文献。
共检索到299项研究，其中30项符合纳入标准。HIV感染与未感染的胸膜结核患者在细胞及细胞因子谱所显示的免疫发病机制上明显不同。即使在HIV感染患者中，腺苷脱氨酶和干扰素γ也是胸膜结核的良好标志物。未感染HIV的结核疑似患者合并胸腔积液时，结核分枝杆菌的检出率通常较低，但有证据表明，双重感染患者涂片及培养的检出率较高。Xpert MTB/RIF检测在提高HIV阳性患者胸膜结核诊断方面具有显著潜力。
HIV感染患者的胸膜结核与未感染HIV患者的胸膜结核免疫发病机制不同，这些结果部分支持了本系统综述中所指出的差异。研究应聚焦于开发基于干扰素γ的即时诊断检测方法，以及扩大Xpert在胸膜结核诊断中的作用。
