PURPOSE: The objective of this study is to determine the differences in the clinical and chest x-ray features of HIV-positive and HIV-negative pulmonary tuberculosis patients on DOTS at the National Hospital Abuja.
METHODS: The clinical features of all smear positive pulmonary tuberculosis patients were recorded at diagnosis, completion of intensive phase, at fifth, seventh month and at completion of DOTS. Only samples seropositive with both stat-pak and determine were considered HIV positive. Genie was used as tie-breaker. Chest x-rays were done at diagnosis, on completion intensive phase and at the end of DOTS treatment. The results were analysed using SPSS version 13.0.
RESULTS: All the 390 patients studied had cough of greater than 3 weeks. Hemoptysis was found in 68(36.9%) of the HIV-positive patients as against 144(75%) in the HIV-negative patients. This difference is statistically significant. p=0.001. There was an observed significant difference in the sputum AAFB density between the HIV positive and the HIV- negative patients. 17(7.2%) of HIV positive and 12(5.7%) of the HIV negative patients) had + sputum density (P=0.03. The chest x-rays features at diagnosis of the HIV positive patients showed fibrosis 59(29.9%), cavitory 41(22.3%),pleural effusion 10(5.4%) and infiltrates 8(4.3%) as against fibrosis 84(40.7%), cavitary 65(31.2%, pleural effusion 5(2.4%)and infiltrates 8(3.9%) in the HIV negative patients. The difference is not statistically significant (p=0.143).
CONCLUSION: The observed significant difference in hemoptysis and sputum AAFB density cannot be generalized because of the relatively small sample size studied.The less fibrosis, cavitory lesions and more infiltrates seen on chest x-rays of HIV positive patients though not statistically significant highlights the challenge of using chest x-ray in the diagnosis and management of PTB in the HIV-positive patients.
CLINICAL IMPLICATIONS: The low sputum AAFB density in HIV-positive patients found in this study highlights the challenges of diagnosiing TB in the HIV positive with paucibacillary or negative sputum smear.The use of additional diagnostic tools (culture,serology and PCR) will result in increased tuberculosis detection rate in developing countries like Nigeria.
DISCLOSURE: Kingsley Osagie, No Financial Disclosure Information; No Product/Research Disclosure Information