PURPOSE: The objectives of this study were: (a) to determine differences in the radiographic patterns of PTB between patients with and without HIV infection and (b) To assess the impact of immunosuppression on radiographic presentation in HIV+ patients.
METHODS: We retrospectively compared the chest radiographs, CT scans and CD4 cell counts of 23 HIV+ patients with active pulmonary tuberculosis with those of 21 HIV− patients admitted to an inner city hospital. The diagnosis of (PTB) was confirmed in all cases by positive cultures.
RESULTS: The mean age of the patients in both groups were 51.1 (SD±12.3 years). 61.4% were males and 38.6% were females. Comparison of the two groups showed that HIV+ patients with pulmonary tuberculosis had higher incidence of pleural effusion (26% vs 9%), mediastinal lymphadenopathy (26% vs 4.8%), infiltrates confined to lower lung fields (39% vs 19%), consolidation (17.4% vs 4.8%) and atelactasis (18.2% vs 10%). Atypical presentation was more common in HIV+ patients than HIV− patients (26% vs 4.8%). Only one case of miliary tuberculosis was seen in HIV+ patients (4.3%). HIV− patients had more cavitory disease (52.4% vs 39.1%); predominance of upper lobe infiltrates (71.4% vs 56.5%) and post- primary tuberculosis pattern (76.2% vs 26%, P= 00.2). In HIV+ patients the mean CD4 cell count was 281(range 25-862/mm3). In HIV+ patients CD4 cell counts of >200/mm3 was associated with cavitations (50% vs 20%) and mediastinal lympadenopathy (40% vs 20%). CD4 cell counts of < 200/mm3 were associated with diffuse parenchymal disease and pleural effusions (40% vs 20%) on CT scans.
CONCLUSION: HIV+ patients with PTB may have atypical radiographic findings, higher incidence of pleural effusion, mediastinal lympadenopathy, infiltrates localized to lower lung fields, more consolidation and atelectasis as compared to HIV− patients. However a study with large sample size is needed to confirm these findings.
CLINICAL IMPLICATIONS: Physicians should be alert to the atypical radiologic spectrum of PTB in HIV+ patients as early diagnosis and appropriate treatment may change the outcome.
DISCLOSURE: Arshad Ali, None.