Radiological patterns in HIV-associated pulmonary tuberculosis: comparison between HAART-treated and non-HAART-treated patients.
OBJECTIVE
To evaluate whether highly active antiretroviral therapy (HAART) modifies radiographic appearances of pulmonary tuberculosis (TB), in terms of patterns and their relative frequencies, among patients with human immunodeficiency virus (HIV) infection.


METHODS
Chest radiographs were obtained in 209 HIV-infected patients with culture confirmed pulmonary TB. Computed tomography (CT) images were also reviewed for 42 patients whose chest radiographs were normal or showed questionable abnormalities. Imaging was evaluated for the presence and distribution of consolidation, cavitation, interstitial changes, pleural disease, adenopathy, and were classified as a primary or post-primary pattern.


RESULTS
A post-primary pattern was more frequent after 1996 when HAART came into clinical use. Forty-four percent (77/176) of patients not on HAART had a post-primary pattern in comparison with 82% (27/33) of patients receiving HAART (p<0.001). A primary pattern was significantly more frequent (p<0.001), in patients with more severe immunosuppression (CD4 lymphocyte less than 200/mm(3)).


CONCLUSIONS
HIV patients receiving HAART with pulmonary TB, had a post-primary pattern more frequently than those not receiving this treatment. This observation is consistent with the partial restoration of cell-mediated immunity that can be induced by HAART.
Busi Rizzi
E
E
Department of Radiology, National Institute for Infectious Disease Lazzaro Spallanzani, Rome, Italy. radiologia@inmi.it
Schininà
V
V
Palmieri
F
F
Girardi
E
E
Bibbolino
C
C
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging*