Clinical features associated with HIV-1 infection in adult patients diagnosed with tuberculosis in Djibouti, Horn of Africa

The US Naval Medical Research Unit headed up a retrospective study of all adult patients diagnosed in 1991 with tuberculosis (TB) at the Paul Faure Hospital Center in Djibouti city. 92% (1844) of the medical records had complete information on demographics clinical and radiological characteristics associated with TB and HIV serological status. 106 (5.7%) patients had HIV-1 infection. Two patients had both HIV-1 and HIV-2 infection. Clinical predictors for HIV seropositivity included peritonitis (odds ratio [OR] = 5.08; p = 0.0164) and pleural effusion (OR = 2.15; p = 0.0037). Ethiopian nationality also predicted HIV infection among TB patients (OR = 2.13; p = 0.0002). The high percentage of glandular TB in this area of Africa even before the HIV epidemic may account for the lack of statistical association between HIV positivity and peripheral lymphadenopathy. These findings indicate that newly diagnosed TB adult patients with peritonitis or pleural effusion are rather likely to also have HIV infection. Physicians should suspect HIV infection in such patients since they may be at high risk of exposure to body fluids during surgery for peritonitis and drainage of pleural effusion. The high variance makes peritonitis and pleural effusion relatively poor predictors of HIV infection however.