Radiographic abnormalities in tuberculosis and risk of coexisting human immunodeficiency virus infection. Results from Dar-es-Salaam, Tanzania, and scoring system.
First, we evaluated the age profile and chest radiographic abnormalities in 146 patients from Dar-es-Salaam, Tanzania, with new-onset intrathoracic tuberculosis (pulmonary, pleural, or hilar/mediastinal adenopathy), to identify features that were associated with human immunodeficiency virus (HIV) seropositivity or seronegativity; then, we combined these data with those from a companion investigation in Burundi to develop a simple scoring system to predict HIV serologic status. Using agreed-upon criteria and simplified reporting forms, initial chest radiographs were reviewed by three readers, first independently and then at a consensus conference. Of the 146 patients, 80 (55%) were HIV seropositive and 66 were seronegative. More seropositive than seronegative subjects were 31 to 40 yr old (p = 0.03). Because the radiographic characteristics of the two serologic groups were similar in Tanzania and Burundi, we combined the data for stepwise logistic regression that revealed four highly significant variables: age, small lesions, location, and lymphadenopathy. From these, we obtained an equation to calculate the probability that a given tuberculosis patients was HIV seropositive and then we derived a scoring system that in its simplest form (threshold) predicted serologic status correctly in 68.1% of patients; a graded scale was even more accurate in the high (89.1%) and low (82.6%) ranges. This scoring system should be useful when serologic testing is unavailable or refused.
Mlika-Cabanne
N
N
Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 13, Hôpital Claude Bernard, Paris, France.
Brauner
M
M
Mugusi
F
F
Grenier
P
P
Daley
C
C
Mbaga
I
I
Larouzé
B
B
Murray
J F
JF
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002063:Burundi; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging*; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D016015:Logistic Models; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011336:Probability; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013636:Tanzania; D014388:Tuberculosis, Lymph Node / Q000150:complications* / Q000000981:diagnostic imaging*; D014396:Tuberculosis, Pleural / Q000150:complications* / Q000000981:diagnostic imaging*; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging*