SummaryOBJECTIVE To elucidate the relationship between HIV, CD4 ϩ count and pleural TB. METHOD In a prospective study, 94 patients presenting at two large Harare hospitals with clinically suspected pleural TB were enrolled over a 10-month period. All underwent standardized evaluation, closed pleural aspiration and biopsy. Patients receiving directly observed anti-TB therapy were followed-up. RESULTS Pleural TB was diagnosed in 90 individuals (median age 33 years; range 18-65; 64 males); the seroprevalence of HIV was 85%. HIV-positive patients were older than HIV-negative individuals (median age 33 vs 23 years, P ϭ 0.013) and had a significantly lower median CD4 ϩ count (191 vs 1106 ϫ 10 6 /l respectively, P ϭ 0.004). A CD4 ϩ count of Ͻ200 ϫ 10 6 /l was associated with a length of illness Ͼ30 days (65% vs 37%; P ϭ 0.05), a positive pleural fluid smear (37% vs 0%; P ϭ 0.0006) and a positive pleural biopsy Ziehl-Neelsen stain (35% vs 7%; P ϭ 0.021). However, a relationship between CD4 ϩ count and either pleural granuloma formation or radiological evidence of disseminated disease was not observed. CONCLUSION In sub-Saharan Africa, TB pleural effusions have become associated with older age, a chronic onset, and an increased mycobacterial load. These data emphasize the complex relationship between pleural TB, HIV infection and a low CD4 ϩ count.keywords pleural tuberculosis, HIV, granuloma, CD4 lymphocyte, Zimbabwe correspondence R. S.Heyderman,

Although HLA‐linked hemochromatosis greatly increases the risk for hepatocellular carcinoma in people of European ancestry, iron overload in Africa is not thought to be etiologically related to this malignancy. To determine if African iron overload may be associated with hepatocellular carcinoma, we reviewed 320 consecutive diagnostic liver biopsies processed at the University of Zimbabwe from 1992 to 1994 and we selected for analysis 215 biopsies from adults that were suitable for the histological assessment of hepatocellular iron. Subjects were stratified according to hepatocellular iron grades of 0–2+ (normal levels to mild siderosis; n=183) and grades of 3+ and 4+ (distinctly elevated levels consistent with iron overload; n=32). Thirty‐six subjects had hepatocellular carcinoma. Logistic regression modeling revealed a significant association between iron overload and hepatocellular carcinoma after adjustment for age, sex and and the presence of portal fibrosis or cirrhosis (p=0.041). The odds of hepatocellular carcinoma in subjects with iron overload was 3.1 (95% confidence interval of 1.05–9.4) times that of subjects without iron overload. While we could not test for exposure to viral hepatitis or to aflatoxins in this study, our findings suggest that iron overload may be a risk factor for hepatocellular carcinoma in Africa.

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