Tubercle and Lung Disease (1996) 77, 244-249 © 1996 Pearson Professional Ltd Comparative histopathological study of pulmonary tuberculosis in human immunodeficiency virus-infected and non-infected patients G. Di Perri*, A. Cazzadori**, S. Vento*, S. Bonora*, M. Malena*, L. Bontempini*, M. Lanzafame*, B. Allegranzi*, E. Concia *Institute of lmmunology and Infectious Diseases, ?Bronchoscopy Unit, CDepartment of Pathology, University of Verona, Verona, Italy. S U M M A R Y. Setting: Clinical features of human immunodeficiency virus (HIV)-associated tuberculosis de- pend upon the patients' residual immunity. An immune-dependent presentation has also been described at the histopathological level in many extra-pulmonary sites, but no descriptions have so far been made on the histopathology of HIV-associated pulmonary tuberculosis. Objective: To compare the histopathological features of pulmonary tuberculosis in HIV-infected subjects and seronegative patients. Design: We carried out a retrospective comparative study on 16 HIV-infected subjects and 16 seronegative patients with culture-proven pulmonary tuberculosis who underwent transbronchial biopsy. We evaluated the bacillary burden and the parenchymai inflammatory reaction by means of a four-graded scoring system giving an approximate quantitative measure of the two parameters. Results: HIV-associated pulmonary tuberculosis was found to differ significantly from disease forms seen in seronegative patients, with a significant tendency to develop highly bacillary and poorly reactive histopathological pictures along with the downgrading evolution of immune function. Conclusion: Pathologic features of pulmonary tuberculosis in HIV-infected subjects differ from those encoun- tered in seronegative patients depending upon the individual immunity of the former. HIV-associated progres- sive depletion of CD4+ lymphocytes leads to substantial changes in pulmonary reactivity to Mycobacterium tuberculosis; multibacillary pictures in a background of loose inflammatory reactions are quite common find- ings at the extreme phase of HIV-related immune deterioration. R ES UME. Cadre: Les caract6ristiques eliniques de la tuberculose associ6e au VIH d6pendent du degr6 d'immunit6 r6siduelle des patients. L'immunod6pendance de l'aspect 16sionnel a 6galement 6t6 d6crite au niveau histopathologique dans de nombreux sites extrapulmonaires, mais jusqu'ici aucnne description n'avait 6t6 faite de l'histopathologie de la tuberculose pulmonaire associ6e au VIH. Objector: Comparer les caract6ristiques histopathologiques de la tuberculose pulmonaire chez les sujets infect~s par le VIH et les patients s6ron6gatifs. Schdma: Nous avons conduit une 6tude comparative r6trospective sur 16 sujets infect~s par le VIH et 16 pa- tients s6ron6gatifs qui tous avaient une tuberculose pulmonaire confirm6e par la culture et avaient subi une biopsie trfinsbronchique. Nous avons 6valu6 la charge bacillaire et la r6action parenchymateuse inflammatoire par un syst6me de score h quatre degr6s donnant une mesure quantitative approximative de ces deux param~tres. Rdsultats: La tuberculose pulmonaire associ~e au VIH diff~re de fa~on significative des formes de maladie observ6es chez les patients s6ron6gatifs, avec une tendance significative ~ d6velopper une charge bacillaire 6lev6e et un aspect histopathologique faiblement r~actif parall~lement h l'~volution d6gressive de la fonction immunitaire. Conclusion: Les aspects anatomopathologiques de la tuberculose pulmonaire chez les sujets infect~s par le VIH different de ceux rencontr6s chez les patients s6ron6gatifs, en rapport avec l'immunit6 individuelle des pre- Correspondence to: Giovanni Di Peril, Istituto di Immunologia e Malattie Infettive, Universita' di Verona, Ospedale Civile Maggiore (Borgo Trento), 37126 Verona, Italy. Tel. and Fax (automatic switch) +39 45-834 9314. Paper received 20 July 1995. Final version accepted 15 December 1995. 244