Clinical and radiographic features of HIV-related tuberculosis.
Human immunodeficiency virus (HIV)-related tuberculosis can be life-threatening for the individual, transmissible to others, and difficult to diagnose. We review the clinical, radiographic, and histopathologic features of HIV-related tuberculosis, and the ways in which these features are affected by the degree of immunodeficiency. At CD4 cell counts greater than 350 cells/microL, HIV-related tuberculosis has a similar presentation to tuberculosis in HIV-uninfected adults, predominantly pulmonary involvement with fibronodular and/or cavitary infiltrates. With progressive immunodeficiency, extrapulmonary involvement becomes increasingly common. Pulmonary involvement remains common at all stages of HIV disease, but the radiographic pattern is very different among persons with advanced immunodeficiency, in whom the most common abnormalities are intrathoracic adenopathy, focal lower or middle lobe infiltrates, and diffuse miliary or nodular infiltrates. The keys to the diagnosis of HIV-related tuberculosis are knowledge of the epidemiology of tuberculosis, recognition of the ways that immunodeficiency changes the clinical presentation, and an assiduous effort to obtain specimens for mycobacterial smear and culture.
Burman
William J
WJ
Denver Public Health and the Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver, CO, USA. bburman@dhha.org
Jones
Brenda E
BE
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D017677:Age Distribution; D018791:CD4 Lymphocyte Count; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014374:Tuberculin Test; D014376:Tuberculosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D014481:United States / Q000453:epidemiology; D019562:Viral Load