10.8 Other HIV-related problems which may occur in TB/HIV patients

Tumours..... KAPOSI’S SARCOMA (KS)

KS can affect many parts of the body, but usually the skin and mouth, and sometimes the lung and pleura, gastrointestinal tract, and pericardium. The clinical appearance is usually distinctive. There is often oedema with KS on the face and legs. Diagnostic confusion can arise with keloids, leprosy, sarcoidosis, and melanoma. In case of doubt, a biopsy is diagnostic. Histology shows typical proliferation of spindle cells and small blood vessels.

Consider a TB/HIV patient with KS. Development of a pleural effusion or progressive lung infiltrations during anti-TB treatment is probably due to KS.

Many countries have limited resources for treating KS. Treatment is often unsatisfactory. Non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve pain. Cytotoxic chemotherapy and radiotherapy may be available in some central hospitals.

............ LYMPHOMA

AIDS patients are at increased risk of developing atypical, aggressive lymphomas. Prognosis is poor even with cytotoxic chemotherapy.

Anaemia

Anaemia in TB/HIV patients may be due to any of the following: TB, HIV-induced marrow suppression, concurrent infections, drug side-effects. Treatment is supportive: iron and folic acid; blood transfusion if essential.

Thrombocytopenia

The main causes are HIV-induced autoimmune thrombocytopenia and drug side-effects. High-dose steroids may help if there is bleeding and the platelet count is low (less than 20 × 10⁹/l).

Renal disease

HIV-related nephropathy causes nephrotic syndrome and progressive renal damage. There is no specific treatment. Treat urinary tract infections in the usual way.

Congestive cardiomyopathy

Consider HIV-related congestive cardiomyopathy in the differential diagnosis of heart failure. Treat heart failure in the usual way.

Arthropathy

Pyrazinamide often causes joint pains but rarely arthritis. HIV-related arthropathy usually affects small joints. NSAIDs may help relieve pain.

Hypoadrenalism

Cytomegalovirus can cause necrotising adrenalitis. This is difficult to distinguish from TB of the adrenal glands or pseudoadrenal crisis (rifampicin). Treatment is with steroid supplements.

SUGGESTIONS FOR FURTHER READING

WHO Global Programme on AIDS. Guidelines for the clinical management of HIV infection in adults. Geneva, 1991.

WHO Global Programme on AIDS. Guidelines for the clinical management of HIV infection in children. Geneva, 1993.

WHO Global Programme on AIDS. AIDS in Africa: a manual for physicians. Geneva, 1992.

WHO Global Programme on AIDS. AIDS home care handbook. Geneva, 1993.

WHO Global Programme on AIDS. Management of sexually transmitted diseases. Geneva, 1994.

Maher D, Mwandumba H. Cryptococcal meningitis in Lilongwe and Blantyre, Malawi. J Infect 1994, 24: 82-83