Radiographic Appearances of Pulmonary Tuberculosis in HIV-1 Seropositive and Seronegative Adult Patients

ABSTRACT

Objective (of this study is) To describe the radiographic pattern of PTB in HIV-1 seropositive and seronegative patients and to study the relationship between radiographic pattern and degree of immunosuppression based on CD4 counts. Design: Cross-sectional; descriptive study. Setting: TB tratment centre and Department of Radiology; Mulago Referral Hospital and Makerere University Medical Teaching Hospital; Uganda. Subjects: One hundred and fiffty consecutive adult patients; suspected on clinical grounds to have TB. Interventions: Three early morning sputum specicimens and 10 mls of venous blood taken from each qualifying subject. Main outcome measures: Chest x-ray changes and CD4 counts. Results: More than sixty eight per cent of the patients were HIV-1 seropositive. Slightly over seventy two per cent of the seropositives were moderate to severely immunosuppresed; 27.2were mildly immunosuppressed; while 6.4were moderately immunosuppressed. Lung parenchymal opacities were demonstrated in 98.7of all patients. Intrathoracic lymphadenopathy and cavitation were noted in 43.3and 41.3respectively. Fibrosis and pleural effusion were observed in 25.0and 25.3respectively. Miliary disease occurred in 2.0. Seropositives accounted for 81.5and 76.3of patients with lymphadenopathy and pleural effusion; 18.5and 23.7respectively were seronegative. Seronegatives accounted for 64.9and 64.5of those with fibrosis and cavitation respectively; whereas 35.135.5of fibrosis and cavitation respectively were seropostive. Patients who were moderate to severely immunosuppressed accounted for 64.6and 63.2of patients with lymphadenopathy and pleural effusion; 35.4and 36.8respectively had normal immune status or were mildly immunosuppressed.Fibrosis and cavitary disease were more frequent in normal or mildly immunosupressed (78.4and 72.6) than in moderately to severely immunosuppressed patients (21.6and 27.4) (p0.001). Conclusion: HIV-seropositivity with moderate to severe immunosuppression are associated with atypical radiographic appearances in adult post primary PTB