The impact of coinfection with human immunodeficiency virus and pulmonary tuberculosis on the success of bronchial artery embolisation

Objective: Pulmonary tuberculosis (PTB) is often associated with human immunodeficiency virus (HIV) in South Africa. Bronchial artery embolisation (BAE) is a specialised, expensive and risky procedure. The aim of this study was to investigate the impact of coinfection with HIV and PTB on the success of BAE. Methods: A retrospective cross-sectional study of sequential BAE procedures during 2006 and 2007 was performed. Rates of procedural and clinical outcome, reasons for failures and the impact of cluster of differentiation cell type 4 (CD4) level on failure were investigated. Patients were included if they presented with massive or life-threatening haemoptysis with a diagnosis of previous or active PTB and their HIV status was known, for the first two attempts at BAE only. Results: The study population consisted of 74 patients who were HIV positive and 33 who were HIV negative. Statistically, procedural success did not imply a clinically successful outcome, and HIV status and CD4 level did not correlate significantly with procedural success. Statistically, no technical reason had an impact on the success of the procedure when correlated with HIV status. The detection of lymphadenopathy was noted in 19.1% of patients who were HIV positive and in 42.4% of patients who were HIV negative, and was the only feature of significance. Conclusion: Coinfection with HIV does not have an impact on the success of BAE in patients with active PTB or with the sequelae of PTB who present with massive or life-threatening haemoptysis. Technical success does not imply clinical success, regardless of HIV status. Improvement in technique locally may improve outcome. Advances in knowledge: PTB coinfection with HIV should not affect the decision to consider BAE.