Relationship between the radiographic pattern of pulmonary tuberculosis and CD4 cell count in patients with human immune deficiency virus infection

Abstract

Background: The chest radiographic appearances of human immunodeficiency virus (HIV)-seropositive patients presenting with pulmonary tuberculosis (PTB) are diverse, creating difficulty in diagnosis and treatment. This study determined the relationship between the degree of immunosuppression and the various radiological patterns of PTB in HIV-infected patients with TB. Materials and Methods: Sixty consecutive patients with PTB, and positive for HIV antibodies as detected using enzyme-linked immunosorbent assay and confirmed by immunoComb 11 (IMMUNOCOMBFIRM), who presented at the infectious diseases clinic of University of Maiduguri Teaching Hospital, Maiduguri and fulfilled the inclusion criteria were included in to a prospective cross-sectional study after obtaining an informed written consent. CD4+ lymphocytes counts were obtained for all the patients. Posterior anterior and lateral chest radiographs were obtained. The chest radiographic images were evaluated for the presence of either typical or atypical patterns of PTB. Results: The mean CD4 counts of those with typical and atypical PTB pattern were 339.8 ± 139.52 and 138 ± 41.78 cells/μl, respectively (P = 0.001). Majority of the patients with typical pattern had a CD4 count of ≥200 cells/μl and they belonged to the HIV/PTB on highly active antiretroviral therapy (HAART) group (56.3%) as against 21.4% of HIV/PTB antiretroviral (ARV)-naive patients. More of HIV/PTB patient who were ARV-naive and had CD4 count Conclusion: We concluded that radiographic patterns of PTB in HIV varied over a spectrum and are related to HIV disease stage and that atypical radiographic pattern was a good predictor of low CD4 counts.