Radiographic appearances of pulmonary tuberculosis in HIV-1 seropositive and seronegative adult patients.
OBJECTIVE
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.


METHODS
Cross-sectional, descriptive study.


METHODS
TB treatment centre and Department of Radiology, Mulago Referral Hospital and Makerere University Medical Teaching Hospital, Uganda.


METHODS
One hundred and fifty consecutive adult patients, suspected on clinical grounds to have PTB.


METHODS
Three early morning sputum specimens and 10 mls of venous blood taken from each qualifying subject.


METHODS
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 immunosuppressed, 27.2% were mildly immunosuppressed or had normal immune status. Approximately ninety three per cent of the seronegative individuals had normal immune status or were mildly immunosuppressed, while 6.4% were moderately immunosuppressed. Lung parenchymal opacities were demonstrated in 98.7% of all patients. Intrathoracic lymphadenopathy and cavitation were noted in 43.3% and 41.3% respectively. Fibrosis and pleural effusion were observed in 25.0% and 25.3% respectively. Miliary disease occurred in 2.0%. Seropositives accounted for 81.5% and 76.3% of patients with lymphadenopathy and pleural effusion, 18.5% and 23.7% respectively were seronegative. Seronegatives accounted for 64.9% and 64.5% of those with fibrosis and cavitation respectively, whereas 35.1% 35.5% of fibrosis and cavitation respectively were seropositive. Patients who were moderate to severely immunosuppressed accounted for 64.6% and 63.2% of patients with lymphadenopathy and pleural effusion, 35.4% and 36.8% respectively had normal immune status or were mildly immunosuppressed. Fibrosis and cavitary disease were more frequent in normal or mildly immunosuppressed (78.4% and 72.6%) than in moderately to severely immunosuppressed patients (21.6% and 27.4%) (p<0.001).


CONCLUSIONS
HIV-seropositivity with moderate to severe immunesuppression are associated with atypical radiographic appearances in adult post primary PTB.
Kawooya
V K
VK
Uganda People's Defence Forces, Mbuya.
Kawooya
M
M
Okwera
A
A
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000276:immunology; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D018023:HIV Seronegativity / Q000276:immunology; D006679:HIV Seropositivity / Q000000981:diagnostic imaging* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D011859:Radiography; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging*