Cavitary pulmonary tuberculosis HIV-related.
BACKGROUND
It was usually assumed that pulmonary tuberculosis (TB) in HIV-seropositive patients represents reactivation TB, despite the radiographic appearance frequently consistent rather with a recent disease. Hence, these radiographic features were considered "atypical". We have hypothesised that the so called "atypical" radiographic features could be due to a greater proportion of primary TB among these patients, representing the typical appearance of primary radiological pattern.


METHODS
We reviewed chest imaging of 219 HIV+ patients with microbiological proven pulmonary tuberculosis, who were assessed for the presence, number, distribution of cavitations and for associated pulmonary parenchymal abnormalities, adenopathies and pleural effusion, and were classified as a primary or post-primary pattern.


RESULTS
The patients with post-primary pattern were 50%, and the rate of cavitation was 63%, not wandering off the general population. Cavities still occurred with similar proportion in groups with CD4 <200 or >200cells/mm(3).


CONCLUSIONS
We suggest that HIV-related pulmonary tuberculosis is typical in its radiological appearances, consistent with those of the general population, and this could be confirmed by the most recent molecular epidemiological techniques that allow to definitely classify the tuberculosis episodes as either primary or post-primary disease.
Department of Radiology, National Institute for Infectious Diseases, Lazzaro Spallanzani, Servizio di Radiologia, Via Portuense 292, 00149 Roma, Italy. radiologia@inmi.it <radiologia@inmi.it>
Elisa
E
Busi Rizzi
Vincenzo
V
Schininà
Fabrizio
F
Palmieri
Enrico
E
Girardi
Corrado
C
Bibbolino
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology*