Significant variation in presentation of pulmonary tuberculosis across a high resolution of CD4 strata.
BACKGROUND
The human immunodeficiency virus (HIV) alters the presentation of pulmonary tuberculosis (PTB), but it remains unclear whether alterations occur at a CD4 cell threshold or throughout HIV infection.


OBJECTIVE
To better understand the relationship between CD4 count and clinical and radiographic presentation of PTB.


METHODS
Initial presentations of culture-confirmed PTB patients evaluated at a Ugandan national TB referral center and an affiliated research unit were compared by HIV status and across 11 CD4 cell count strata: 0-50 to >500 cells/μl.


RESULTS
A total of 873 HIV-infected PTB cases were identified. Among HIV-infected PTB cases with CD4 < 50, 21% had a normal chest X-ray (CXR) vs. 2% with CD4 > 500, with a continuous trend across CD4 strata (test for trend, P < 0.001). All radiographic manifestations of PTB displayed significant trends across CD4 strata. HIV-infected vs. non-HIV-infected patients had no significant difference in CXR findings of miliary patterns or pleural effusion at CD4 > 100, normal CXR or fibrosis at CD4 > 150, adenopathy at CD4 > 250, and cavitation or upper lung disease at CD4 > 300. Twenty-three per cent of co-infected cases with CD4 < 50 and 1% with CD4 > 500 had negative acid-fast bacilli (AFB) smears, with a significant trend between (P < 0.001).


CONCLUSIONS
Variations in CXR appearance and AFB smear correlate with CD4 decline in significant, continuous trends.
Chamie
G
G
HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, California 94110, USA. gabriel.chamie@ucsf.edu
Luetkemeyer
A
A
Walusimbi-Nanteza
M
M
Okwera
A
A
Whalen
C C
CC
Mugerwa
R D
RD
Havlir
D V
DV
Charlebois
E D
ED
D001431:Bacteriological Techniques; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D015658:HIV Infections / Q000150:complications / Q000276:immunology* / Q000821:virology; D006801:Humans; D016015:Logistic Models; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000276:immunology / Q000382:microbiology; D014454:Uganda