The greatest causes of morbidity and mortality in patients infected with human immunodeficiency virus are opportunistic infections and neoplastic diseases. Most of them are lung diseases. Its correct diagnosis and proper treatment improve the quality of life as well as the survival in this group of patients.

Keywords: lung disease; acquired immunodeficiency syndrome; bronchoscopy

Objective: To compare clinical, radiological, and laboratory characteristics of individuals with pulmonary tuberculosis co-infected or not with HIV. Methods: A cross-sectional study, in which signs and symptoms were assessed by anamnesis and physical examination in patients hospitalized with pulmonary tuberculosis. The results of sputum smear microscopy and culture for Mycobacterium tuberculosis, as well as hemoglobin levels and CD4+ T-cell counts, were obtained from medical records, and chest X-ray reports were consulted. Results: We included 50 pulmonary tuberculosis patients, who were divided into two groups (HIV-positive and HIV-negative; n = 25 per group). The mean age of the participants was 38.4 ± 10.5 years; 46 (92%) were males; and 27 (54%) were White. Expectoration was presented by 21 (84%) and 13 (52%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016). Radiological findings of cavitation were present in 10 (43%) and 2 (10%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016), whereas an interstitial pattern was observed in 18 (78%) and 8 (40%), respectively (p = 0.012). The mean hemoglobin level was 11.1 ± 2.9 g/dL and 9.3 ± 2.2 g/dL in the HIV-negative and HIV-positive groups, respectively (p = 0.015). Conclusions: In our sample of tuberculosis patients, expectoration was less prevalent, hemoglobin levels were lower, and cavitation was less common, as was an interstitial pattern, among those co-infected with HIV than among those without HIV co-infection.

Keywords: HIV; Tuberculosis; Acquired immunodeficiency syndrome.

Objective: To look for correlations between radiological patterns and CD4+ T cell counts in patients coinfected with tuberculosis and human immunodeficiency virus. Methods: Patients included were selected from among those presenting human immunodeficiency virus/tuberculosis coinfection and admitted to the Nereu Ramos Hospital, located in Florianópolis, Brazil, between January of 2000 and December of 2003. Results: A total of 87 patients were included. The mean age was 34 + 8 years, and 6.8% were non-Caucasian. The mean CD4+ T cell count was 220.2 cells/mm3 (median, 144 cells/mm3), and 56.4% of the patients presented less than 200 cells/mm3. We identified the following radiographic patterns and related them to the CD4+ T cell counts: the alveolar pattern in 50.6% of the cases (56.8% CD4+ T cells < 200); the interstitial pattern in 32.2% (53.6% CD4+ T cells < 200); pleural effusion in 24.1% (47.6% CD4+ T cells < 200); cavitation in 24.1% (57.1% CD4+ T cells < 200); enlarged mediastinal or hilar lymph nodes in 11.5% (90% CD4+ T cells < 200); and a normal pattern in 11.5% (60% CD4+ T cells < 200). The mean CD4+ T cell counts for the radiologic patterns isolated were as follows: 235.2/mm3 (alveolar consolidation); 208.8/mm3 (interstitial); 243.3/mm3 (pleural effusion); 265/mm3 (cavitation); 115.1/mm3 (enlarged mediastinal or hilar lymph nodes) (p < 0.05); and 205.5/mm3 (presenting no radiological alterations). As noted, mediastinal/hilar lymph node enlargement was the only pattern that correlated with the degree of cell-mediated immunity in a statistically significant way. Conclusion: With the exception of mediastinal/hilar lymph node enlargement, the radiographic patterns were randomly distributed in relation to the CD4+ T cell counts.

Keywords: Tuberculosis, pulmonary; HIV infections; Lung/radiography; AIDS-related opportunistic infections; CD4 lymphocyte count; T-lymphocytes, helper-inducer

Bronchoscopy with bronchoalveolar lavage, bronchial brush, and transbronchial biopsy are useful methods for the diagnosis of pulmonary diseases in patients infected with the human immunodeficiency virus (HIV). However, data on the accuracy of these techniques are conflicting. In order to estimate the sensitivity of the bronchoalveolar lavage, bronchial and transbronchial biopsy in pulmonary disease diagnosis in patients infected with HIV, the authors studied 71 consecutive patients, most of them with respiratory symptoms up to 15 days (58%) and radiologic signs of interstitial infiltrates (62%). The sensitivity was calculated taking as reference a constructed gold-standard, represented by the sum of all three techniques combined. Sensitivities for bronchoalveolar lavage, transbronchial biopsy, and bronchial brush were 86%, 43% and 5%, respectively. The association of bronchoalveolar lavage and transbronchial biopsy reached the sensitivity to 100%, reflecting how the gold-standard was constructed. The complication rate of the procedures was 3%. These results suggest that, in this population: (1) bronchoscopy with bronchoalveolar lavage, bronchial brush, and transbronchial biopsy are secure procedures with good diagnostic performance; (2) bronchoalveolar lavage alone has reached the highest sensitivity, whereas both bronchoalveolar lavage and transbronchial biopsy can be considered complementary techniques; (3) the association of bronchoalveolar lavage and transbronchial biopsy performed better than bronchoalveolar lavage alone; and (4) the use of bronchial brush in the sequence used in this protocol did not have any influence on the performance of diagnosis.

Keywords: Human immunodeficiency virus. Lung diseases. Diagnostic techniques. HIV. Lung infections.

The objective of this study was to describe temporal trends in tuberculosis morbidity and mortality in the state of Santa Catarina, Brazil, between 2002 and 2009. Data regarding mortality and incidence were obtained from the Brazilian Mortality Database and National Case Registry Database, respectively. Crude rates were calculated and standardized by age using the direct method. We estimated annual variation by joinpoint regression, identifying the points at which there were changes in the trends. There was a significant (3.7%) annual decrease in the mortality rate. In the study period, two distinct temporal trends were identified: one between 2002 and 2007, showing a significant (5.9%) annual decrease in the mortality rate; and one between 2007 and 2009, showing an insignificant (2.0%) annual increase. There was also a significant (0.9%) annual reduction in tuberculosis incidence.

Keywords: Tuberculosis/epidemiology; Tuberculosis/mortality; Brazil.

Objective: To examine the relationship between gastroesophageal reflux (GER) and COPD exacerbations. Methods: We conducted a systematic search of various electronic databases for articles published up through December of 2012. Studies considered eligible for inclusion were those dealing with COPD, COPD exacerbations, and GER; comparing at least two groups (COPD vs. controls or GER vs. controls); and describing relative risks (RRs) and prevalence ratios-or ORs and their respective 95% CIs (or presenting enough data to allow further calculations) for the association between GER and COPD-as well as exacerbation rates. Using a standardized form, we extracted data related to the study design; criteria for GER diagnosis; age, gender, and number of participants; randomization method; severity scores; methods of evaluating GER symptoms; criteria for defining exacerbations; exacerbation rates (hospitalizations, ER visits, unscheduled clinic visits, prednisone use, and antibiotic use); GER symptoms in COPD group vs. controls; mean number of COPD exacerbations (with symptoms vs. without symptoms); annual frequency of exacerbations; GER treatment; and severity of airflow obstruction. Results: Overall, GER was clearly identified as a risk factor for COPD exacerbations (RR = 7.57; 95% CI: 3.84-14.94), with an increased mean number of exacerbations per year (mean difference: 0.79; 95% CI: 0.22-1.36). The prevalence of GER was significantly higher in patients with COPD than in those without (RR = 13.06; 95% CI: 3.64-46.87; p < 0.001). Conclusions: GER is a risk factor for COPD exacerbations. The role of GER in COPD management should be studied in greater detail.

Keywords: Pulmonary disease, chronic obstructive; Gastroesophageal reflux; Meta-analysis; Risk factors; Evidence-based medicine.