Determination of the effect of highly active antiretroviral therapy on radiographic features of pulmonary tuberculosis in HIV infected patients

Abstract

Background: The chest radiographic appearances of HIV-seropositive patients presenting with pulmonary tuberculosis (PTB) are diverse, creating difficulty in diagnosis and treatment. Determination of the effect of highly active antiretroviral therapy (HAART) on radiographic features of pulmonary tuberculosis among HIV infected patients was investigated in order to find out the pattern in our environment and to provide an empirical approach for early diagnosis and treatment of patients. Aim: The aim of this study is to determine the effect of HAART on radiographic features of pulmonary tuberculosis in HIV-infected patients. Materials and Methods: A cross sectional study of 60 consecutively confirmed HIV- seropositive patients who had been diagnosed of the infection for at least six months before the commencement of this study, aged between 19 and 50 years (Mean ± SD: 32.9 ± 7.15) comprising 22 males and 38 females with newly diagnosed sputum smear positive PTB was conducted at the infectious disease clinic of the University of Maiduguri Teaching Hospital, between March 2010 and February 2011. The subjects were HIV/PTB patients on HAART for at least 6 months before presenting with PTB (32) and HIV/PTB but Antiretroviral (ARV)-naive who were already confirmed HIV positive for at least 6 months before presenting with PTB (28). Posterior-anterior (PA) and lateral chest radiographs were obtained with film screen at 50-70 kVp in majority of the patients. CD4 + lymphocyte counts were obtained for all the patients. The chest radiographic images were evaluated for the presence of either typical or atypical patterns of PTB. Apical opacities with or without cavitations was considered typical while atypical patterns included miliary, lower or mid-zone consolidation, reticulonodular opacities, pleural effusion, hilar adenopathy and normal radiograph. Results: Majority (78.6%) of HIV/PTB patients on HAART with CD4 counts of ≥ 200 cells/μl had typical pattern of PTB whereas atypical pattern of PTB was significantly seen in HIV/PTB ARV naive patients with majority of this group of patients (62.5%) had CD4 count of <200 cells/μl (P = 0.001). Conclusion: Majority (78.6%) of HIV/PTB patients on HAART had typical pattern of PTB whereas atypical pattern of PTB was significantly seen in HIV/PTB ARV naive patients (62.5%) (P = 0.001). We concluded that radiographic patterns of PTB in HIV varied over a spectrum and are related to HIV disease stage and HAART treatment.