Article

Pulmonary tuberculosis: Radiological differences in West Africans coinfected with HIV

Department of Medicine, School of Medical Sciences, University of Science & Technology, Kumasi, Ghana, West Africa.
British Journal of Radiology (Impact Factor: 2.02). 04/1999; 72(856):339-44. DOI: 10.1259/bjr.72.856.10474493
Source: PubMed

ABSTRACT A retrospective study was performed to document and compare the radiological appearances of newly diagnosed pulmonary tuberculosis (PTB) in groups of West African patients with (n = 86) and without (n = 106) human immunodeficiency virus (HIV) coinfection. Analysis of chest radiographs showed that the HIV-positive group had less consolidation (mean 3.1 zones vs 3.7 zones; p < 0.05), less apical involvement (64.0% vs 85.5%; p < 0.001), less bronchopulmonary spread (27.9% vs 58.5%; p < 0.001), less volume loss (53.5% vs 76.4%; p < 0.001) and less pleural thickening (46.5% vs 61.3%; p < 0.05) compared with the HIV-negative group. However, HIV-positive patients more commonly had pleural effusions (17.4% vs 6.6%; p < 0.05) and lymphadenopathy (9.3% vs 1.9%; p < 0.05). Previous studies on this subject from sub-Saharan Africa have focused either on selected patient groups likely to have more advanced immunosuppression or on smear-positive cases only, or where there has been only limited radiological documentation. This study suggests that the highly significant differences that exist may not be as frequent as previously shown. The lower frequencies of bronchopulmonary pattern of consolidation and pleural thickening in HIV-positive subjects have not previously been documented. The possible reasons for the altered radiographic appearance of PTB in HIV positive subjects are discussed.

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    • "Rapid and accurate diagnosis of tuberculosis especially in those co-infected with HIV infection is therefore expedient in order to substantially reduce morbidity and mortality. Although sputum smear microscopy for acid-fast bacilli (AFB) is the first-line diagnostic test for evaluating these patients, with overwhelmingly reported evidences that HIV-infected patients with pulmonary TB are less often smear positive, chest radiography (CXR) is valuable and recommended in establishing cases of tuberculosis especially in those with negative sputum smears [4] [5] [6]. "
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    ABSTRACT: Wasting remains an important condition in HIV-infected patients receiving highly active antiretroviral therapy (HAART). In this study, 120 patients with newly diagnosed HIV infection were prospectively evaluated to determine the effect of HAART on body mass index (BMI). Eighty-nine (83.1%) patients gained weight, 5 (4.7%) had no weight change, and 13 (12.2%) lost weight. There was a significant increase in overweight and obese patients. On multivariate analysis, time-updated CD4 count and higher baseline BMI were associated with a greater increase in BMI. Anaemia at diagnosis was associated with a significant increase in BMI. There were no significant effects of age, sex, disease severity, viral load or educational status on BMI changes. About 27% of the HIV patients presented with weight loss, which emphasizes that weight loss and wasting remain important AIDS-defining conditions, despite the advent of HAART. A linear association was observed between time-updated CD4 count and increase in BMI. The association between time-updated CD4 count and greater increase in BMI suggests that BMI could be a surrogate for CD4 count in monitoring treatment response in resource-limited settings.
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    • "Rapid and accurate diagnosis of tuberculosis especially in those co-infected with HIV infection is therefore expedient in order to substantially reduce morbidity and mortality. Although sputum smear microscopy for acid-fast bacilli (AFB) is the first-line diagnostic test for evaluating these patients, with overwhelmingly reported evidences that HIV-infected patients with pulmonary TB are less often smear positive, chest radiography (CXR) is valuable and recommended in establishing cases of tuberculosis especially in those with negative sputum smears [4] [5] [6]. "
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    ABSTRACT: We compared the pattern and distribution of pulmonary lesion on chest radiograph of HIV patients with CD4 count < or ≥200cells/μl and HIV-1RNA viral load < or ≥ log105. Of the 133 patients consecutively recruited, 84 (63.2%) had CD4 count <200 cells/μl. Patients with CD4 count <200 cells/μl had consolidation (15.5% vs 28. P = 0.054) and streaky changes 39.3% vs 55.9%, P = 0.049) less often. Pulmonary lesions involving upper and middle radiological zones were less common in cohort with CD4 count < 200cells/μl (11.9% vs 30.5%, P = 0.006), conversely middle and lower zone involvement were most often seen in them (27.4% vs 15.3%, P = 0.008). Patients with HIV-1 RNA viral load ≥105copies/ml had nodular lesions less often (31.7% vs 55.1%, p = 0.038) and more often had hilar or mediastinal lymphadenopathy (22.0% vs 7.3%, P = 0.012). Lower zone involvement was predominantly seen in cohort with HIV-1 RNA viral load ≥105copies/ml (19.5% vs 0.01%, p = 0.000). Our study demonstrates association between HIV disease stage with pattern and distribution of certain tuberculosis lesion on chest radiograph. Knowledge of immunological and virological parameters is important to clinicians and radiologist when evaluating CXR findings in HIV-infected patients.
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    ABSTRACT: Background : HIV is the most common risk factor for reactivation of latent TB and is associated with increased rate of progression of infection to disease. Radiological presentation of TB is variable in both HIV (-) and HIV (+) patients but is more in the latter. In this study we describe and analyze radiological presentation of TB/HIV patients in Massih Daneshvari hospital in IRAN. Materials and Methods : We registered the demographic, clinical and laboratory information of TB/HIV patients in Massih- Daneshvari hospital between 2002-2003. Inclusion criteria were standard serologic test for HIV (Two positive Elisa test and one positive westernblot test) and proof of TB with clinical and mycobacteriologic or pathologic criteria. Chest x-ray was reported by pulmonary imaging specialist and was divided to two category: Typical (fibrocavitary infiltration in posteroapical segment of upper lobes) and atypical (opacity in middle and lower lobe, hilar and mediastinal adenopathy, pleural effusion, diffuse nodular opacity and normal X-ray). Findings were analyzed using SPSS version 10.5. Results : 15 patients, 13 men (86.7%) and 2 women were included. Mean (±SD) of CD 4 count was 229.15 ± 199.45. 53.3% of patients had adenopathy, 26.7% had pleural effusion. Only one patient had cavitary disease. Radiographic pattern was typical in one (6.7%) and atypical in 93.3% of patients. In regard to severity of radiological presentation, mild; moderate and severe pattern was seen in 40%, 26.7% and 33.3% respectively.
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