Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression

Abstract

Medical charts and radiographs from 38 HIV-infected patients with positive cultures for Mycobacterium tuberculosis from sputum or bronchoalveolar lavage were reviewed in order to compare the clinical, radiographic, and sputum bacilloscopy characteristics of HIV-infected patients with pulmonary tuberculosis according to CD4+ lymphocyte count (CD4). The mean age of the patients was 32 years and 76% were male. The median CD4 was 106 cells/mm³ and 71% had CD4 < 200 cells/mm³. Sputum bacilloscopy was positive in 45% of the patients. Patients with CD4 < 200 cells/mm³ showed significantly less post-primary pattern (7% vs. 63%; p = 0.02) and more frequently reported weight loss (p = 0.04). Although not statistically significant, patients with lower CD4 showed lower positivity of sputum bacilloscopy (37% vs. 64%; p = 0.18). HIV-infected patients with culture-confirmed pulmonary tuberculosis had a high proportion of non-post-primary pattern in thoracic radiographs. Patients with CD4 lower than 200 cells/mm³ showed post-primary patterns less frequently and reported weight loss more frequently.

Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

“…Although the clinical and radiological manifestations of TB in HIV-infected patients are known to vary according to the degree of immunosuppression [7][8][9][10][11][12][13], no studies have specifically described radiographic abnormalities in patients with CD4+ T-cell counts below 50 cells mm -3 , a population at particularly high risk of poor outcomes. Therefore, we carried out a cross-sectional study of adult patients admitted to the emergency ward of a national referral hospital with suspected TB.…”

HIV and Tuberculosis: a Deadly Human Syndemic

“…As the CD4 cell count declines, the frequency of cavitation in pulmonary TB decreases. Data were pooled from 12 studies (6,19,34,66,71,105,143,144,159,199,208,210) that examined the frequency of lung cavitation associated with CD4 counts in patients coinfected with HIV and pulmonary TB. Patients whose CD4 count was above 200 cells/l had a 4-fold-higher odds of having cavitary pulmonary TB than those with CD4 counts below 200 cells/l (odds ratio, 4.44; 95% CI, 3.36, 5.88).…”

Manifestações clínicas, radiológicas e laboratoriais em indivíduos com tuberculose pulmonar: estudo comparativo entre indivíduos HIV positivos e HIV negativos internados em um hospital de referência

“…(8,14) Pleural effusion was more common in the present study (25.5%) than in other studies, in which the proportion of tuberculosis patients In another study, (25) the prevalence of pleural effusion was found to be higher in patients with a CD4 + T-cell count > 200 cells/mm 3 . However, another group of authors (22) found that pleural effusion was more common in individuals with a CD4 + T-cell count < 200 cells/mm 3 . The HIV-positive patients analyzed in the present study had mean CD4 + T-cell counts that were quite close to the cut-off point of 200 cells/ mm 3 , and this might have influenced the results obtained.…”

“…A review of tuberculosis and malnutrition reported greater weight loss among the tuberculosis patients who were co-infected with HIV. (17) One group of authors (22) found that, among HIV-positive patients, those with a CD4 + T-cell count above 200 cells/mm 3 lost the least amount of weight.…”