Tuberculosis in people living with human immunodeficiency virus might be overlooked

Background. Diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) is a major challenge, since clinical and imaging findings are often atypical. Objective. To analyze how TB was confirmed and the role played by the histologic examination in people living with HIV (PLHIV) and we report two cases in which TB treatment was delayed since the TB diagnosis was made shortly before or after the patient died. The secondary objective was to assess factors associated with death in this population. Methods. We performed a retrospective observational study of PLHIV with microbiology and/or histology confirmed TB, admitted in two infectious diseases university hospitals, between January and December 2015. Results. We identified 99 patients and we included in the study 69 patients who met the inclusion criteria. Pulmonary TB (PTB) cases accounted for 51% (35 patients) of the cases, 13 (19%) patients had extrapulmonary TB (EPTB), and 21 (30%) patients had simultaneous PTB and EPTB. Fifteen (22%) patients included in the study died. We report two cases in which TB treatment was delayed since the TB diagnosis was made shortly before or after the patient died. Although a higher mortality rate was found in IVDUs (30%), in patients with EPTB (26%) and in patients with drug-resistant-TB (36%), deaths were only associated with a lower CD4 cell count at TB diagnosis. Conclusions. In a high endemic setting for TB the biopsy should be more frequently performed for the diagnosis of EPTB, particularly in populations like PLHIV, which are at a higher risk.