Impact of human immunodeficiency virus type-1 infection on the initial bacteriologic and radiographic manifestations of pulmonary tuberculosis in Uganda. Makerere University-Case Western Reserve University Research Collaboration.
METHODS
TB Treatment Centre, Kampala, Uganda.


OBJECTIVE
To evaluate the impact of human immunodeficiency virus (HIV) co-infection on the bacteriologic and radiographic presentation of pulmonary tuberculosis (TB) in Uganda, a nation with high rates of Mycobacterium tuberculosis and HIV infection.


METHODS
To compare baseline characteristics among HIV-infected and non-HIV-infected adults with initial newly-diagnosed episodes of culture-confirmed pulmonary TB screened for participation in a randomized prospective TB treatment trial.


RESULTS
Negative and paucibacillary (very scanty or scanty) sputum acid fast bacilli (AFB) smears were more frequent in HIV-infected patients presenting with pulmonary TB (P = 0.007). More HIV-infected individuals also had sputum cultures that required 7-8 weeks incubation until positivity than non-HIV-infected patients (P < 0.01). Lower lung field and diffuse pulmonary infiltrates were more frequent among HIV-infected patients. Rates of atypical X-ray presentations and cavitary disease were comparable between HIV-seropositive and -seronegative patients; however, atypical disease was more frequent in HIV-infected patients with small tuberculin reactions or tuberculin anergy (PPD = 0 mm).


CONCLUSIONS
HIV co-infection was associated with a higher frequency of negative and paucibacillary sputum AFB smears. The differences in the diagnostic yields of microscopy and culture between HIV-infected and non-HIV-infected individuals were small and do not, in our opinion, significantly affect the utility of these important diagnostic tests in developing countries. Examining more than one sputum specimen and monitoring cultured specimens for a full 8 weeks may assist in optimizing the diagnostic yield. Upper lobe infiltrates and cavitary disease are still the most frequent radiographic presentations of pulmonary TB in HIV-infected and non-HIV-infected adults in countries with a high prevalence of TB.
Johnson
J L
JL
Department of Medicine, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Ohio 44106-4984, USA. jlj@po.cwru.edu
Vjecha
M J
MJ
Okwera
A
A
Hatanga
E
E
Byekwaso
F
F
Wolski
K
K
Aisu
T
T
Whalen
C C
CC
Huebner
R
R
Mugerwa
R D
RD
Ellner
J J
JJ
D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011446:Prospective Studies; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D013183:Sputum / Q000382:microbiology; D013828:Thioacetazone / Q000627:therapeutic use; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D014454:Uganda
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D013828:Thioacetazone